Use of a closed communication service for social support networks to diagnose and treat conditions in subjects

ABSTRACT

Methods and systems are described for diagnosis and/or treatment of physical or mental conditions, disorders, disabilities or illnesses, injuries, and chronic conditions. According to one embodiment, a communications network that provides a closed communication service to facilitate and encourage affective communication, activity stimulating communication and/or intellectually stimulating communication among members of a caregroup and a target of the caregroup is used as a method of treatment for (i) a physical or mental condition, disorder, disability or illness, (ii) an injury, and/or (iii) a chronic condition of the target. According to another embodiment, such a closed communication service is used as a method of facilitating (i) diagnosis of the target&#39;s mental or physical status, (ii) evaluation of the target&#39;s response to service stimuli and treatments and condition over time; and/or (iii) making prognoses regarding progression of physical or mental condition, disability, disease or chronic conditions of the target.

This application claims the benefit of Provisional Application No.60/514,172, filed Oct. 24, 2003 which is hereby incorporated byreference in its entirety.

COPYRIGHT NOTICE

Contained herein is material that is subject to copyright protection.The copyright owner has no objection to the facsimile reproduction ofthe patent disclosure by any person as it appears in the Patent andTrademark Office patent files or records, but otherwise reserves allrights to the copyright whatsoever. Copyright © 2003-2004 CaringFamily,LLC.

BACKGROUND

1. Field

Embodiments of the present invention generally relate to diagnosis of,and treatment for, mental disabilities or illnesses, physical illnesses,injuries, and chronic conditions, and in particular to the use of aclosed communication service that facilitates and encourages generationand delivery of digital gifts among members of a caregroup and an eldersubject that is a target of the caregroup to slow, ameliorate, prevent,or remedy a particular condition and/or as a treatment for theparticular condition.

2. Description of the Related Art

Medical research suggests increased social interaction may (i) decreasethe risk of developing a physical or mental condition, disorder,disability or illness, or a chronic condition; and (ii) have a profoundeffect on the longevity and well-being of an elder in decline.

Faber, A., & Wasserman, S. (2001). Social support and social networks:Synthesis and review. In Levy, J., and Pescosolido, B. (eds.) SocialNetworks and Health. Advances in Medical Sociology, 8, 29-72. Stamford,Conn.: JAI Press.

-   -   “Research has shown that lack of social interaction leads to        disabilities, depression, and even death for the elderly.”

Glass, Thomas: Population based study of social and productiveactivities as predictors of survival among elderly Americans, August1999 in the British Medical Journal

-   -   “Social and productive activities that involve little or no        enhancement of physical fitness lower the risk of all causes of        death as much as exercise does,”    -   “Social engagement was as strong as anything we found in        determining longevity. It was stronger than things like blood        pressure, cholesterol, or other measures of health.”    -   “Physical fitness is important, but social engagement is turning        out to be just as critical to longevity. What I tell people is,        ‘Find something you really like doing that involves other        people, whether it's playing cards or walking in the mall.’        Social engagement adds a sense of purpose to people's lives. It        also seems to add years to those lives.”    -   “Conclusions Social and productive activities that involve        little or no enhancement of fitness lower the risk of all causes        of mortality as much as fitness activities do. This suggests        that in addition to increased cardiopulmonary fitness, activity        may confer survival benefits through psychosocial pathways.        Social and productive activities that require less physical        exertion may complement exercise programmes and may constitute        alternative interventions for frail elderly people.”

Social Isolation and Social Loneliness by Madelyn Hall and Betty Havens(http://www.hc-sc.gc.ca/seniors-aines/naca/writings_gerontology/writ18/writ18_(—)3_e.htm)

-   -   Social isolation and social loneliness are situations that tend        to increase as people age, and as family and friend-networks        become smaller. Social contacts generally decrease after        retirement, and may continue to decline with the deaths of        family members and friends, and changes in residence following        widowhood, mobility difficulties, and ill health    -   Social isolation and social loneliness have consistently been        found to be associated with health. Social isolation and        loneliness negatively influence health; and, conversely,        declining health status may also lead to increased social        isolation and accompanying feelings of loneliness. Perceived        loneliness has been found to be one of the strongest predictors        of health status among institutionalized seniors, and numerous        studies have demonstrated that health is related to the        emotional well-being of people in their later years. A greater        use of health care services, such as physician visits and        prescription medications, have also been found to be related to        higher levels of loneliness. In addition, self-rated health is        related to feelings of loneliness, in that there appears to be a        relationship between higher levels of loneliness and lower        self-ratings of health.

On the possibility of communications providing important intellectualstimulus:

Verghese, J., Lipton, R. B., et al. (2003). Leisure Activities and theRisk of Dementia in the Elderly. New England Journal of Medicine. 348;25. 2508-2516.

-   -   “ . . . elderly persons who did crossword puzzles four days a        week had a risk of dementia that was 47 percent lower than among        subjects who did puzzles once a week.”

Yapko, Michael D. Originally published by Psychology Today: May/June

-   -   “We've known for decades that relationships serve as buffers        against illness and emotional disorders. The people who are at        the greatest risk for depression are those who are most lonely.”

Ellen McGrath—Originally published by Psychology Today: July/August 2003

-   -   “Checking in on people's well-being and not just on their        activity schedule contributes to a sense of connectedness that        is a major buffer against depression at every stage of life.        Paying as much attention to family feelings as family activities        is one of the best protections you can use to combat family        depression.”

NIMH Depression research:

-   -   “Depression frequently co-occurs with a variety of other        physical illnesses, including heart disease, stroke, cancer, and        diabetes, and also can increase the risk for subsequent physical        illness, disability, and premature death.”    -   “recent NIMH studies show that 13 to 27 percent of older adults        have subclinical depressions that do not meet the diagnostic        criteria for major depression or dysthymia but are associated        with increased risk of major depression, physical disability,        medical illness, and high use of health services. Subclinical        depressions cause considerable suffering, and some clinicians        are now beginning to recognize and treat them.”

Surgeon General Report on Depression—“Psychosocial Treatment ofDepression”:

-   -   Most research to date on psychosocial treatment of mental        disorders has concentrated on depression. These studies suggest        that several forms of psychotherapy are effective for the        treatment of late-life depression, including        cognitive-behavioral therapy, interpersonal psychotherapy,        problem-solving therapy, brief psychodynamic psychotherapy, and        reminiscence therapy, an intervention developed specifically for        older adults on the premise that reflection upon positive and        negative past life experiences enables the individual to        overcome feelings of depression and despair (Butler, 1974;        Butler et al., 1991). Group and individual formats have been        used successfully.”

From The Effect Of Social Isolation And Loneliness On The Health OfOlder Women (http://www.pwhce.ca/effectSocialIsolation.htm)

-   -   “The odds of being lonely were more than double for those who        lived alone versus those who lived with others, and about 1.4        times greater for those who felt their health was poor, who were        widowed, or who had few social contacts. Having more than four        chronic illnesses was also a significant influence, as was        evidence of limited functioning. Because these factors are        independent, they are additive. The result, then, is that a        widow who lives alone, sees few other people and feels her        health is poor would be almost six-and-a-half times more likely        to be lonely than a married individual who lives with a spouse,        sees many people on a regular basis, and is in good health.”    -   “The odds of being socially isolated (having fewer contacts)        were 1.7 times greater for women than men, 1.3 times greater        among those who were older with poor self-rated health, and 1.1        times greater for those with more chronic illness. An        accumulation of these effects would mean that a woman over age        80 and in poor health would be almost five-and-a-half times more        likely to be socially isolated than men younger than age 80 and        in better health.”

From: John W. Rowe, M. D. and Robert L. Kahn, PhD, “Successful Aging:The MacArthur Foundation Study,” Random House, 1998

-   -   “Active engagement with life is achieved by close personal        relationships with family and friends, and with continued        involvement in productive activities.”    -   “As a rule, people whose connections with others—family, spouse,        and members of a organization—are relatively strong tend to live        longer.”

From: Jon F. Nussbaum Pennsyivania State University Loretta L. PecchioniLouisiana State University James D. Robinson University of Dayton TeresaL. Thompson University of Dayton Communication and Aging (Lea'sCommunication Series) . . . LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS 2000Mahwah, New Jersey London

-   -   “people without close interpersonal ties are more than twice as        likely to die than their counterparts with close interpersonal        ties. . . . Not only does communication play an important role        in determining people's mental and physical health, but, in        addition, after they become ill, their communicative        relationships seem to influence how quickly they get well.”

From: “Cognitive impairment, depressive symptoms, and functional declinein older people,” by Kala M. Mehta, D. Sc., Kristine Yaffe, M. D., andDr. Covinsky, in the June 2002 Journal of the American GeriatricsSociety 50, pp. 1045-1050.

-   -   “ . . . the relative risk of 2-year functional decline doubles        for those with cognitive impairment and/or depressive symptoms.”

From: UC Davis Health Article on Depression:

-   -   “A strong network of social support is both important for        prevention and recovery from depression.”

Regarding risks to caregivers:

From http://www.reutershealth.com/wellconnected/doc31.html

-   -   “Studies show that caregivers of physically or mentally disabled        family members are at risk for chronic stress.”    -   “Spouses caring for a disabled partner are particularly        vulnerable to a range of stress-related health threats including        influenza, depression, heart disease, and even poorer survival        rates. Caring for a spouse with even minor disabilities can        induce severe stress.”    -   “Intervention programs that are aimed at helping the caregiver        approach the situation positively can be very helpful at        reducing stress and helping the caregiver maintain a positive        attitude.”    -   “Wives experience significantly greater stress from caregiving        than husbands, and, according to a 2000 study, tend to feel more        negative about their husbands than caregiving husbands feel        about their wives.”    -   “Specific risk factors that put caregivers at higher risk for        severe stress or stress-related illnesses include the following:        -   Having a low income.        -   Being African American. (African Americans tend to be in            poorer physical health than Caucasians and so face greater            stress as caregivers to their spouses than their Caucasian            counterparts.)        -   Living alone with the patient.        -   Helping a highly dependent patient.        -   Having a difficult relationship with the patient.”

From: Helpguide,http://www.helpguide.or/elder/alzheimers_disease_dementias_caring_caregivers.htm

-   -   “Seven out of every ten Alzheimer's patients live at home.        Family and friends provide more than 75% of home care. Paid        caregivers provide the remaining 25% of home care.”    -   “Depression is more common in those giving care to patients with        Alzheimer's Disease than it is in the patients themselves. 15%        of all people over age 65 are depressed. 20% of those with        Alzheimer's Disease are depressed. 50% of the caregivers for        Alzheimer's patients are depressed.”    -   “The elder with Alzheimer's Disease or other dementia may        decline so much that they no longer seem like the same person.        The caregiver is relating to a vestige of the former human        being. The caregiver may get no rewards for their daily efforts,        and they may feel isolated from the outer world and deeply        depressed. Depression is the most common ailment of the        caregiver: depression from the isolation, depression because of        the unrelenting caregiving, depression because they are unable        to relieve the elder's pain and misery. The caregiver may find        themselves wishing that the elder would die, not only to end the        elder's miserable state of life, but also to end the        caregiving.”    -   “The range of emotional and physical problems that the caregiver        may develop are:        -   increased stress and tension        -   depression, often continuing for several years after the            patient has died        -   anxiety        -   anger        -   guilt        -   grief        -   frustration        -   decreased overall life satisfaction        -   decreased satisfaction with social networks        -   strained family relationships that may result from            resentment and miscommunication about caring for the elder        -   increased health problems and greater use of healthcare            services        -   increased use of psychotropic medications        -   isolation”    -   “In addition to increased mental and physical stress, the        caregiver for an elder with Alzheimer's or other dementia may        become physically abusive to the elder. This physical abuse        sometimes is in response to the patient's physical aggression        toward the caregiver.”    -   “The caregiver must always guard their own mental and physical        state. Two avenues of self-care are:        -   Take care of your own health so that you can care better for            the elder with dementia.        -   Avoid isolation: seek support and relief.”

This site also suggests the following existing support and reliefmechanisms for caregivers:

-   -   “Join a formal caregiver support group. This reduces your        depression and distress, and it ends up improving life for the        patient.    -   Meet with other family caregivers, away from the elder, to        support each other.    -   Join a computer support network.    -   Get professional individual counseling and support. Research has        shown that this, above all, can relieve the strain of caring for        the Alzheimer's patient.    -   Maintain a sense of humor.    -   Accept or ask for help from others.    -   Consider respite care to temporarily relieve you from your        caregiving duties.”

From: Family Caregiver Alliancehttp://www.caregiver.org/caregiver/jsp/content_nodejsp?nodeid=393

-   -   “Caregiving is the backbone of the American long-term care        system: the value of the services provided by informal        caregivers (family or friends of seriously ill loved ones) is        estimated at $257 billion annually.”

Consequently, a need exists for methods and systems for managing andinfluencing the quantity, quality, effect and timeliness ofcommunications to one or more target(s) of a social support network,such as one or more elder(s) or their resident caregiver, from theirsocial support network.

SUMMARY

Methods and systems are described for diagnosis and/or treatment ofphysical or mental conditions, disorders, disabilities or illnesses,injuries, and chronic conditions. According to one embodiment, acommunications network that provides a closed communication service tofacilitate and encourage one or more of affective communication,activity stimulating communication and intellectually stimulatingcommunication among members of a caregroup and subject(s) that are atarget of the caregroup is used as a method of treatment for one or moreof (i) a physical or mental condition, disorder, disability or illness,(ii) an injury, and (iii) a chronic condition of the subject.

According to another embodiment, a communications network that providesa closed communication service to facilitate and encourage one or moreof affective communication, activity stimulating communication andintellectually stimulating communication among members of a caregroupand a target of the caregroup is used as a method of improvingwell-being or reducing stress of a primary, residential caregiver of thetarget.

According to another embodiment, a purposefully supported communicationssystem is provided which increases affective communication, activitystimulating communication and intellectually stimulating communicationbetween an elder and a caregroup associated with the elder thereby (i)reducing risk of disease, depression and physical and mental decline,and (ii) increasing longevity, activity and quality of life.

According to another embodiment, a method of coaching is provided withina closed communication service that is configured to facilitate andencourage communications among members of a caregroup and a target ofthe caregroup. The target of the caregroup uses a hardcopy-basedcommunication appliance associated with the caregroup to transmit andreceive electronic communications via the closed communication serviceto or from the members of the caregroup. Identification, creation anddelivery of appropriate member-to-member and member-to-target coachingmessages is facilitated by providing within the closed communicationservice one or more tools that allow one or more administratingcaregivers of the caregroup to view metrics relating to electroniccommunications exchanged via the closed communication service.

According to another embodiment, a closed communication service tofacilitate and encourage electronic communications among members of acaregroup and a subject that is a target of the caregroup is used as amethod of supporting a spouse, sibling or resident offspring of thesubject and preventing one or more of depression, stress and physicalillness due to caregiving activities performed by the spouse, sibling orresident offspring on behalf of the subject.

According to another embodiment, a method is provided within acommunication service to facilitate assessment and diagnosis of thecondition of a subject and to facilitate prognoses regarding thecondition of the subject. The communication service is configured tofacilitate and encourage communications among members of a caregroup anda subject that is a target of the caregroup. The subject uses a digitalmailbox appliance associated with the caregroup to transmit and receiveelectronic communications via the communication service to or from theplurality of members of the caregroup. Information is captured regardingcommunications via the communication service among the members of thecaregroup and the subject. Then, information is provided to healthcareproviding caregivers to assess and diagnose the condition of the subjectand to make prognoses regarding the condition of the subject.

According to one embodiment an automated method of coaching within acommunication service is provided. The communication service isconfigured to facilitate and encourage communications among members of acaregroup and a subject that is a target of the caregroup. The subjectuses a hardcopy-based communication appliance associated with thecaregroup to transmit and receive electronic communications via thecommunication service to or from the members of the caregroup.Information is captured regarding communications exchanged among theplurality of members of the caregroup and the subject via thecommunication service and one or more metrics based on the capturedinformation are calculated. Based on the one or more metrics, thecommunication service automatically generates and delivers coachingmessages in an effort to encourage a set of goals, including one or moreof (i) frequent communications among the members of the caregroup andthe subject, (ii) affective communications, and (iii) stimulating oractivity inducing communications.

According to another embodiment, a closed communication service thatfacilitates and encourages electronic communications among members of acaregroup and an elder subject that is a target of the caregroup is usedas a method of facilitating one or more of (i) diagnosis of the eldersubject's mental or physical status, (ii) evaluation of the eldersubject's response to closed communication service stimuli andtreatments and condition over time; and (iii) making prognoses regardingprogression of physical or mental condition, disability, disease orchronic conditions of the elder subject.

According to another embodiment, a method is provided to facilitatediagnosis of subpopulations of disease or disability and evaluate ordiscover new methods of diagnosis or intervention strategies to slow,ameliorate, prevent or remediate chronic conditions in elders or thosewith mental or physical conditions, disabilities or diseases byanalyzing aggregate data from multiple caregroups participating in aclosed communication service.

According to another embodiment, a closed communication service thatfacilitates and encourages electronic communications among members of acaregroup and a target of the caregroup is used as a method of providinginformation to family members regarding indications of physical ormental condition, disorder, disability or illness of a participatingfamily member.

Other features of embodiments of the present invention will be apparentfrom the accompanying drawings and from the detailed description thatfollows.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present invention are illustrated by way of example,and not by way of limitation, in the figures of the accompanyingdrawings and in which like reference numerals refer to similar elementsand in which:

FIG. 1 illustrates a typical cycle of decline that may be experienced byan elder family member.

FIG. 2A is a block diagram conceptually illustrating a high-levelarchitectural view of a communications system in accordance with oneembodiment of the present invention.

FIG. 2B is a block diagram conceptually illustrating various collectionsof functionality packages and their relation to the communication systemplatform according to one embodiment of the present invention.

FIG. 3A conceptually illustrates communication flow among a socialsupport network.

FIG. 3B illustrates increased communication with the targeted recipientas well as among the social support network resulting from use of anembodiment of the present invention.

FIG. 4 is a block diagram conceptually illustrating a communicationarchitecture according to one embodiment of the present invention.

FIG. 5 is an example of a computer system with which embodiments of thepresent invention may be utilized.

FIG. 6A illustrates a member login user interface screen according toone embodiment of the present invention.

FIG. 6B illustrates a caregroup selection user interface screenaccording to one embodiment of the present invention.

FIG. 7 illustrates a caregroup home page user interface screen accordingto one embodiment of the present invention.

FIG. 8 illustrates a member registration user interface screen accordingto one embodiment of the present invention used by caregroupadministrators to register a new member to their caregroup.

FIG. 9 is a software architecture block diagram conceptuallyillustrating application-level software components of the distributionserver, web server, and internal components of the digital mailboxaccording to one embodiment of the present invention.

FIG. 10 is a flow diagram illustrating a method of performing contentderived addressing according to one embodiment of the present invention.

FIG. 11 illustrates a sample completed routing form and resulting emailmessage delivered to the addressee according to one embodiment of thepresent invention.

FIG. 12 illustrates a sample completed return-reply requested form thatmay be created and delivered to a digital mailbox appliance responsiveto a caregroup member request according to one embodiment of the presentinvention.

FIG. 13 illustrates another sample completed return-reply requested formthat may be created and delivered to a digital mailbox applianceresponsive to a caregroup member request according to one embodiment ofthe present invention.

FIG. 14 illustrates another sample completed routing form that may beprovided by the communication service provider to a digital mailboxappliance user and customized for the user according to one embodimentof the present invention.

FIG. 15 illustrates a sample coaching message and associated form thatmay be directed to a digital mailbox appliance user according to oneembodiment of the present invention.

FIG. 16 illustrates a sample completed greeting card form, eCard form,originated at a digital mailbox appliance and a resulting eCardgenerated responsive thereto according to one embodiment of the presentinvention.

FIG. 17 is a flow diagram illustrating a method of performing automateddispatch according to one embodiment of the present invention.

FIG. 18 is a flow diagram illustrating a method of performing coachingand monitoring analysis according to one embodiment of the presentinvention.

FIG. 19 illustrates a user interface screen depicting a coaching messageeditor for a weekly summary according to one embodiment of the presentinvention.

FIG. 20 illustrates a review coaching message user interface screenaccording to one embodiment of the present invention.

FIG. 21 illustrates a member activity user interface screen summarizinginformation regarding communications by members of a particularcaregroup according to one embodiment of the present invention.

FIG. 22 illustrates a drill down member activity user interface screenlisting communications by a specific member of a caregroup according toone embodiment of the present invention.

FIG. 23 illustrates an exemplary chart or dashboard monitor for effectsof communications delivered to a particular elder that may be displayedwithin a user interface screen according to one embodiment of thepresent invention.

FIG. 24 illustrates an exemplary chart or dashboard monitor ofcommunications delivered to a particular elder by caregroup member thatmay be displayed within a user interface screen according to oneembodiment of the present invention.

FIG. 25 illustrates an exemplary chart or dashboard monitor of digitalgifts by category delivered to a particular elder that may be displayedwithin a user interface screen according to one embodiment of thepresent invention.

FIG. 26 is a flow diagram illustrating a method of performing goodguessing according to one embodiment of the present invention.

FIG. 27 illustrates a member personal information user interface screenaccording to one embodiment of the present invention.

FIG. 28 illustrates an elder's schedule user interface screen accordingto one embodiment of the present invention.

FIG. 29 illustrates an example of a user interface screen depicting aphoto essay type digital gift according to one embodiment of the presentinvention.

FIG. 30 illustrates a user interface screen depicting an initial (blank)photo essay (or photo journal) type of digital gift with embedded editstimulus markers according to one embodiment of the present invention.

FIG. 31 illustrates a user interface screen depicting a personalizableready made eCard type of digital gift resulting from good guessingaccording to one embodiment of the present invention.

FIG. 32 illustrates various user interface screen shots, selection froma collection of digital gifts and good guessing defaults according toone embodiment of the present invention.

FIG. 33 is a flow diagram illustrating a method of interacting withpop-up forms according to one embodiment of the present invention.

FIG. 34 illustrates customization and re-rendering of a pop-up in thecontext of a note editor according to one embodiment of the presentinvention.

FIG. 35 illustrates examples of various pop-ups according to oneembodiment of the present invention.

FIG. 36 illustrates examples of various digital gifts according to oneembodiment of the present invention.

FIG. 37 is a graph illustrating a sample plot of an elder's responserate over time.

FIG. 38 illustrates a specific example of a Halloween card 3800 sentduring a field test implemented by the assignee of the presentinvention.

FIG. 39 illustrates examples of various samples of coaching ortherapeutic digital gifts according to one embodiment of the presentinvention in the form of a collage.

DETAILED DESCRIPTION

Methods and systems are described for diagnosis and/or treatment ofphysical or mental conditions, disorders, disabilities or illnesses,injuries, and chronic conditions. According to one embodiment, a digitalmailbox system facilitates receipt and transmission of electroniccommunications without requiring the end user to have a personalcomputer. The digital mailbox system includes a novel architecturethrough which the various interacting parties may use an electroniccommunication access system that suits their particular needs andtechnological comfort level thereby adding grace back to the lives ofboth the elder and their social support network. The novel architecturemay provide various tools and applications to promote communicationsamong members of a social support network. For example, according to oneembodiment, collaborative and/or individual publishing tools areprovided via a website interface to enable collaborative and/orindividual development of a daily delivery of a digital publication,such as a newsletter-like publication or the like, for communication toelders by friends, caregivers, family and volunteers. In one embodiment,members of a social support network may select and/or customize contentfor inclusion in the digital publication from various predefined datastreams (e.g., jokes, business news, global news, local news, health andwellness news, sports news, puzzles, cartoons, weather, etc.) based uponinterests, hobbies and/or cognitive needs (e.g., intellectualstimulation) of the intended recipient. For example, the kinds ofmaterial typical of newspaper syndicated features can be provided, suchas horoscope, literary quote of the day, “on this day in history”,“health tip of the day”, and the like, selected by the members of theelder's social support network to be appropriate to the elder'sinterests. In one embodiment, members of a social support network maycreate or harvest existing family content, such as digitized photos,daily deliveries, digitized art created by children (a/k/a “kid art”),and use it to create various compositions to share among one anotherand/or the digital mailbox appliance user. In one embodiment, ex-officiomembers, such as physicians or other professional caregivers, maymonitor an elder's health status and send/receive confidentialcommunication with the family, the elder or the caregiver, through thedigital mailbox appliance.

Meanwhile, an elder may make use of a dedicated hardcopy device forsending and receiving electronic communications without the need for acomputer, keyboard or mouse. In this manner, the novel architecture actsas a communications transformer by receiving electronic communicationsin one form from the originator of the communication and outputting theelectronic communication in a form suitable for access by an intendedrecipient thereby facilitating communication to and from thosedisinclined or unable to use computers, the internet, and/or homenetworks.

In the following description, numerous specific details are set forth inorder to provide a thorough understanding of embodiments of the presentinvention. It will be apparent, however, to one skilled in the art thatembodiments of the present invention may be practiced without some ofthese specific details. In other instances, well-known structures anddevices are shown in block diagram form.

Embodiments of the present invention include various steps, which willbe described below. The steps may be performed by hardware components ormay be embodied in machine-executable instructions, which may be used tocause a general-purpose or special-purpose processor programmed with theinstructions to perform the steps. Alternatively, the steps may beperformed by a combination of hardware, software, customer servicepersonnel associated with a communication service provider, caregroupmembers serving in a customer service role and/or firmware.

Embodiments of the present invention may be provided as a computerprogram product, which may include a machine-readable medium havingstored thereon instructions, which may be used to program a computer (orother electronic devices) to perform a process. The machine-readablemedium may include, but is not limited to, floppy diskettes, opticaldisks, compact disc read-only memories (CD-ROMs), and magneto-opticaldisks, ROMs, random access memories (RAMs), erasable programmableread-only memories (EPROMs), electrically erasable programmableread-only memories (EEPROMs), magnetic or optical cards, flash memory,or other type of media/machine-readable medium suitable for storingelectronic instructions. Moreover, embodiments of the present inventionmay also be downloaded as a computer program product, wherein theprogram may be transferred from a remote computer to a requestingcomputer by way of data signals embodied in a carrier wave or otherpropagation medium via a communication link (e.g., a modem or networkconnection).

While according to one embodiment, a digital mailbox system is describedas a communication mechanism among families and elders, otherembodiments of the digital mailbox system are equally applicable tofacilitating electronic communications to and from other groups ofindividuals, such as developmentally disabled adults. Furthermore, thecommunications may include unrelated individuals within a common socialsupport network.

While, for convenience, embodiments of the present invention aredescribed with reference to an Application Service Provider (ASP) model,embodiments of the present invention are equally applicable to variousother operational models. For example, the systems and methods describedherein may be deployed in accordance with a model in which theapplication is hosted internally by a organization and made accessibleto various distributed locations of the organization.

Terminology

Brief definitions of terms used throughout this application are givenbelow.

The phrase “administrating caregiver” generally refers to a member of acaregroup that has certain administrative privileges within thecommunication system platform. In one embodiment, administratingcaregivers have access and permissions to operate a communicationsservice dashboard. Administrating caregivers may have the ability to addor remove members to the caregroup, update family data, manage memberviewing, editing and notification permissions, originate coachingprompts, configure many of the VPN and digital mailbox appliancebehaviors like time of elder's daily delivery, default printing font,etc. Caregroups may have one or more administrating caregivers.

The term “caregroup” and the phrases “social support network” and“family support network” generally refer to a collection of individuals,including family, friends, caregivers, volunteers and/or serviceproviders, who are registered members of a VPN associated with a user ofcommunication appliance, such as a digital mailbox appliance. Anindividual may be a member of multiple caregroups. Members may havedifferent viewing, editing and notification permissions independentlyassociated with each caregroup in which they participate. For example,administrative caregiver permissions described above are one such set ofpermissions.

The term “carousel” generally refers to a software implemented contentbuffering mechanism that may receive and store content at one rate andoutput the stored content at another rate. In one embodiment, one ormore carousels are provided by a communication service provider thatallow members of a family support network to collect material, such asfamily photos, items of information, articles, personalized messages,jokes, etc., that will be incorporated over time in a periodic digitalpublication delivered to an elder. In this manner, a family member canautomatically direct selected data feed content to a carousel ormanually place original and/or personalized content into a carousel,whenever he or she has time to do so. Then, content from the carouselmay be included in various periodic digital publications intended forthe elder, such as a daily delivery, when space permits and as needed toprovide content in such periodic digital publications. The bufferingprovided by use of one or more carousels, e.g., photo carousels orpersonalized content carousels, may be used to smooth the resultingcommunication over variations in how much time the members of the familysupport network have to devote to communication or contribution ofcontent or photos. Like photos, items of information from data feeds mayalso be collected in carousels for use over time. A predetermined orcustomizable delay may be established before buffered carousel contentcan be used in the periodic digital publication. This allows members ofthe family support network to examine, filter, edit, personalize and/ordelete unwanted items before they are delivered to the elder. A brief,personal note on a cartoon or joke can add to its affective impact bypointing out a special meaning of the item for the elder or the family.

The phrase “coaching message” generally refers to a message intended todirectly or indirectly encourage activity. According to one embodimentcoaching messages are messages originated internal to a caregroup VPNeither from the communication service provider or a caregroup member orthe user of a communication appliance associated with the caregroup VPNthat encourages or “prompts” the generation of a new message within thecaregroup. For example, a coaching message may directly or indirectlyencourage communication with the user(s) of a digital mailbox applianceor encourage the use of new or under used content types available withinthe communication system platform. Coaching messages may be originatedby staff members and/or administrators of the communication serviceprovider, administrating caregivers, or even the user (e.g., an elder)of a digital mailbox appliance. According to one embodiment, variouscoaching editors are provided within the communication system platformto assist administrating caregiver(s) with the task of creating andsending coaching messages. According to another embodiment, an exofficio professional healthcare provider may send private coachingmessages to a patient, or to the administrative caregiver(s).

In one embodiment, the communication system provider may detect abehavior (or an individual user or a family) and generate a coachingmessage to one or more family members in response to what is detected.For example, a coaching message may simply encourage a family member tocheck in by logging onto the family VPN. Certain automatically generatedcoaching messages may also encourage use of new or under used contenttypes, boost personalization or even add to the members personal data toenhance the overall experience. Other types of coaching messages maysupply intellectual stimulation to the elder, recognize family “days ofnote,” encourage an increase in the affective content of correspondencedirected to the elder, encourage wider group participation, requirespecific responses from the elder, and the like.

The terms “connected” or “coupled” and related terms are used in anoperational sense and are not necessarily limited to a direct connectionor coupling.

The phrase “content derived addressing” generally refers to a processthat permits a user of a communication appliance, such as ahardcopy-based communication appliance or a hardcopy-based emailappliance, to send a message to one or more caregroup members withouthaving to specify an email address, phone number or the like. Rather,the message itself contains sufficient information to allow acommunication service provider to determine the intended addressee(s).According to one embodiment, with a single press of a button on ahardcopy-based communication appliance an elder may have a messagedelivered electronically to any caregroup member as part of an emailmessage.

The phrase “digital gift” generally refers to an electronicallydelivered communication sent by a participant in a social supportnetwork or by the individual(s) that are the focus of the social supportnetwork. Examples of digital gifts include collages of digital photos,simple text messages, email messages, photo essays, ecards, ready madecommunications, FamilyWeather, customized/customizable Health andWellness tips, Kid Art and personalized ready made communications.According to one embodiment, certain ready made digital gifts fordelivery to (or from) an elder can be personalized within a few secondsto a few minutes and electronically delivered message (to or from anelder). Digital gifts may be responses to queries, created in digitalgift editors, parsed out of standard email formats, or derived frompaper forms supplied to the user of a hardcopy communication appliance.Digital gifts often have attractive and emotive decoration and layout.Digital gifts may also contain customized health and wellness statusindicators (including, but not limited to mood, sleep, eating,measurements of body fluids or status). According to one embodiment, theprinted form of digital gifts that are deliverable to a digital mailboxappliance may be adapted for an elder's personal requirements (e.g.,large fonts, high contrast presentation, even adaptation for colorblindness).

The phrase “digital mailbox appliance” generally refers to acommunication appliance or component configured to be associated with acaregroup VPN through a closed communication service. In one embodiment,a digital mailbox appliance is a hardcopy-based communication appliancethat (i) accepts hardcopy input, e.g., paper-based messages, and createsa digital representation of the hardcopy input for electronic delivery,e.g., email delivery of such digital representation or digital giftsbased on such digital representation, to one or more members of thecaregroup associated with the digital mailbox appliance; and (ii)creates hardcopy output, e.g., paper-based messages, responsive toelectronic delivery of communications from caregroup members that aredirected to the user of the digital mailbox appliance. According to oneembodiment, digital mailbox appliances are remotely maintained by acommunication service provider responsive to calls to the communicationservice provider initiated by the digital mailbox appliances. Dependingupon the particular embodiment, a digital mailbox appliance is bothsimpler than a multifunction printer (MFP) and more functional than anMFP. According to one embodiment, a digital mailbox appliance is simplerthan an MFP in that it excludes many MFP features, such as a copier, auniversal serial bus (USB) connection to and operation with a PC (ornetwork of PC's), local control of quality (print and scan). Accordingto one embodiment, a digital mailbox appliance is more functional than aMFP in that it connects to and depends on a closed communicationservice, in that it schedules daily printing, in that it connects to theclosed communication service at a time of it's choosing (modemmanagement based on local configuration). It is envisioned that adigital mailbox appliance may be embedded within other consumer devices,such as printers, fax machines, or the like. Also, in embodiments inwhich hardcopy output is not desired or needed, the digital mailboxappliance may comprise or be part of a cell phone, a personal digitalassistant (PDA), or other current or future handheld wireless devices.

The term “eCard” generally refers to an generally refers to anelectronically delivered communication in the form of a card, such as agreating card.

The term “elder” generally refers to an aging family member, such as aparent or grand parent. Typically, the elder is the user of a digitalmailbox appliance and a center of focus of a social support network,such as a caregroup, and a target recipient of communication services.An elder might also might be an isolated or disabled family member.

The phrase “ex-officio member” generally refers to a member of acaregroup that has been granted access because of some commercial orsupport group relationship to the caregroup. Without limitation,examples include the entity or organization that provides thecommunication service, church groups (e.g., the elder's shut-incommittee of their church), an “attending” home care agency, supportingpersonnel in an assisted living situation, physician, nurse, physician'sassistant, insurance provider . . . etc. Ex-officio members typicallyhave access to specialized customer support tools (though acommunication service provider customer services website). The toolsavailable and access to information within them may be configured foreach caregroup-ex-officio role.

The phrase “helper member” generally refers to a volunteer or commercialcaregiver with member status within a caregroup permitted by theadministrating caregiver. Examples of helper members include members ofa church group, employees of a home care agency, a geriatric consultant,or members of a specialized supporting group (e.g., for Alzheimer'scare).

The phrases “in one embodiment,” “according to one embodiment,” and thelike generally mean the particular feature, structure, or characteristicfollowing the phrase is included in at least one embodiment of thepresent invention, and may be included in more than one embodiment ofthe present invention. Importantly, such phases do not necessarily referto the same embodiment.

If the specification states a component or feature “may”, “can”,“could”, or “might” be included or have a characteristic, thatparticular component or feature is not required to be included or havethe characteristic.

The phrase “photo essay” generally refers to a story accompanied by oneor more photos. Photo essays are typically about an event or adventureand typically include a paragraph or two about each photo and mayinclude several pages of annotated photos. Examples of photo essaysinclude, without limitation, a story about a trip to Belize by the greatgranddaughter, stories about diving trips, a photo home tour of arecently purchased condo, pet essays, a retirement party, a classroomparty, a Tahiti cruise in planning, participation in a major runningrace, several local parades, kids climbing a rock wall, and fishingtrips. According to one embodiment of the present invention, a photoessay digital gift editor is provided that makes it easy to format andcreate this kind of content.

The phrase “presentation components” generally refer to editableelements of a digital gift in a digital gift editor.

The term “project” generally refers to multi-day and/or multi-personcommunication activities, such as the joint creation of an archive offamily recipes, an annotated collection of old family photos, a turntaking game (e.g. scrabble, chess, checkers, . . . ) etc.

The term “responsive” includes completely or partially responsive.

The term “scan,” when used as a noun, generally refers to a digitalrepresentation of a page of correspondence originated at a digitalmailbox appliance.

Overview

Social isolation and loneliness are problems for many elders, and suchconditions are strongly associated with health problems and reducedfeelings of well-being. To address this problem, the methods and systemsdescribed herein seek to promote what Liechti and Ichikawa (1999) callaffective awareness: “a general sense of being in touch with one'sfamily and friends.” According to various embodiments of the presentinvention, communications from a social support network to theindividual(s) that are the focus of the social support network aredesigned to carry not only an informational message but also, moreimportantly, a message of engagement and caring.

Studies of family communication have shown that the actual content orinformation exchanged during or in a communication is not the mostimportant aspect of a communication. Rather, it is the expression ofinterest in the relationship that is of importance as a result of theinitiation of a call or sending of a card or email message. Patrick andMetcalf {Patrick, E. and Metcalf, C. (nd) Mediated communication betweenextended family and friends: A case study. Motorola Labs User ResearchReport at http://internet2.motlabs.com/user/vmc-study/.} have indicated,“The most striking implication . . . is that communication for sharedexperience, so important in maintaining distance relationships, is notadequately supported by the communication media available today.”Embodiments of the present invention also attempt to address this need.

Meanwhile, not only elders but also family caregivers need support thatincreased and better communication can provide. Biegel and Schultz(1999), in their introduction to a special issue of Family Relationsdevoted to family caregivers, note both the prevalence of familycaregiving and the burdens it creates. These can include lack of supportand assistance from other family members. Picot and Lowell (2001)estimate that there are more than 25 million family caregivers in theUnited States, and that many feel a significant burden. In the extreme,family caregivers can suffer caregiver burnout (Lee et al. 2001). TheFamily Caregiver Alliance estimates that “the value of the servicesprovided by informal caregivers (family or friends of seriously illloved ones) is estimated at $257 billion annually.” And, the Center forHealth Aging has found that “Depression is more common in those givingcare to patients with Alzheimer's Disease than it is in the patientsthemselves. 15% of all people over age 65 are depressed. 20% of thosewith Alzheimer's Disease are depressed. 50% of the caregivers forAlzheimer's patients are depressed.”

Embodiments of the present invention seek to manage and influence thequantity, quality, effect and timeliness of coimmunications to a targetof a social support network, such as an elder, from their social supportnetwork to create a large and consistent communications channel todisrupt and/or break the cycle of isolation that leads to decline anddeath. Use of the communications systems and methods described hereinare thought to greatly improve communications among isolated elders andtheir social support networks (primarily their families) and suchimproved communications are expected to provide a palliative effect.Embodiments of the present invention seek to manage and influence thequantity, quality, effect and timeliness of communications to a targetof a social support network, such as an elder's primary caregiver(s),from their social support network to create a large and consistentcommunications channel to disrupt and/or break the cycle depression thatoften leads to health problems and a decline in the level of care forthe elder. Use of the communications systems and methods describedherein are thought to greatly improve communications among primarycaregivers and their social support networks (primarily their extendedfamilies) and such improved communications are expected to provide asupportive and healthy effect.

Embodiments of the present invention provide methods and systems forcreating a virtual private network (VPN) connecting non-computer userswith their social support networks who do use computers, camera phones,and/or email appliances. In one embodiment, coaching techniques areemployed to influence the quantity, quality, effectiveness andtimeliness of electronic communications to and from individualsfrequently isolated from family and friends.

Information technology methods and systems are described herein thatseek to empower participants in a social support network by simplifyingthe task of creating and initiating communications. In the context ofvarious embodiments described herein the methods and systems seek toallow family members to provide more effective support to an elderliving independently. For example, various communications tools make iteasier for family caregivers to provide stimulating and usefulinformation to the elder, helping to sustain health, activity andengagement.

Embodiments of the present invention operate as a communicationtransformer making it possible for family members to communicate withelders using the Internet, without requiring the elders to operate ormaintain a computer. It is contemplated that the methods and systemsdescribed herein will make it easier for family caregivers to shareinformation and ideas among themselves, and increase the general levelof communication within the family generally as well as to and from theelder.

In one embodiment, a proprietary device or set of devices referred to asa “digital mailbox” allows electronic communication with elders. Thedigital mailbox provides a much simpler user interface for the elderthan email or other existing computer applications. The digital mailboxmay incorporate features of a fax machine, a photo printer, and ascanner, backed by servers operated by a communication service provider.A member of a social support network is able to generate email or createa digital gift or contribute to a periodic publication which isdelivered to the elder as a high-quality hardcopy with no interventionrequired by the elder via the communication service provider. Accordingto one embodiment, the elder can send correspondence to a member ofhis/her social support network from his/her digital mailbox by simplyplacing it on a flat scanner bed and pressing a single button. No typingor dialing is required. As described further below with respect tocontent derived addressing, addressing the correspondence mayaccomplished by checking off address information on a routing formprovided by the communication service provider and customized for theelder. In another case described below the addressing the correspondenceis automatic because the form being used is an explicit reply to a priorcommunication. Thus, elders can receive and send electronic messages,including images, with no use of a computer and with an extremely simpleinterface.

According to one embodiment of the present invention, a communicationsystem in which the digital mailbox operates provides an onlineinterface, such as a password protected portion of a web portal, intowhich participants in a social support group my login. The communicationsystem may include various automated communication tools that allowfamily members or others in an elder's social support network to sendengaging, interesting and useful information to the elder. In view ofempirical evidence suggesting elders specifically value predictablecommunication, versus just getting emails every now and then,embodiments of the present invention facilitate the delivery ofinformation to the elder on a predictable schedule, even when theschedules of the participants in the social support network do notpermit such regular communications. The communication system may alsoprovide tools that help family members support one another in theirvarious caregiver roles.

According to one embodiment of the present invention, the digitalmailbox appliance provides an unattended printing feature. Thisunattended printing aspect of the digital mailbox appliance hassignificant impact. In one embodiment, to receive messages and digitalgifts the elder does not have to turn anything on, to login, to use akeyboard, or mouse, or even a TV-like remote control. Gifts and messagessimply appear at a regular time of day much as does the mail deliveredby the US Post Office.

The communication system may also gather information about thecommunications exchanged within participating social support networks toallow assessment of the impact of the communications on elders and/orcaregivers. Impact metrics may then be viewed and analyzed in graphicalform by a social support network administrator, such as a familyrepresentative or other administrating caregiver. Exemplary impactmetrics may include simple counts, assessed value or other measures ofeffects, communications and gift categories by member, by type, and/orduring a specified time period. Effect monitoring may includecalculating an assessed value of affective communications,communications that induce intellectual stimulus and/or communicationsthat induce activity. Communication monitoring may include a simplecount of digital gifts originated by participants in a social supportnetwork and/or the individual(s) that are the focus of the socialsupport network. Digital gift monitoring and analysis may includecategorization of digital gifts and tracking of the number of digitalgifts in the categories (e.g., collages, simple text messages, emailmessages, photo essays, ready made communications, and personalizedready made communications).

FIG. 1 illustrates a typical cycle of decline that may be experienced byan elder family member. Isolation may begin in any of a number of ways,e.g., death of a spouse, kids moving away, restrictions to mobility.Isolation usually leads to a sense of loneliness. Loneliness oftencauses or amplifies depression (clinical or sub-clinical). Depression isstrongly linked with both physical and mental decline. Physical and/ormental decline may lead to further loss of mobility and/or less frequentinteractions with others. This in turn increases isolation and thedownward spiral continues. Family communications can interrupt theisolation slowing and even reversing the decline.

FIG. 2A is a block diagram conceptually illustrating a high-levelarchitectural view of a communications system 200 in accordance with oneembodiment of the present invention. In the embodiment depicted, thecommunications system includes a communication service provider 215,services 225, digital mailbox appliances 240 and 241 used by elders 235and 236, respectively and family, friends, and volunteers 230communicatively coupled through a network 210.

According to one embodiment, the network 140 is a public communicationsnetwork, such as the Internet; however, it is contemplated that smallerscale communication systems may be implemented within a privatecommunications network, such as a local area network (LAN) (e.g., anEthernet LAN or a token ring LAN), an Intranet, an Extranet, a wide areanetwork (WAN) comprising multiple inter-linked LANs and/or leased linesor any other communication structure designed to carry data between aplurality of computers associated with a particular enterprise ororganization.

While for simplicity, in this example, only two elders 235 and 236 arediscussed as being subscribers of communication service provider 215, itis to be understood that the communications service provider 215 mayscale to serve any number of elders and associated caregroup members.Additionally, as mentioned above, while various embodiments of thepresent invention are described in the context of the communicationservice provider 215 serving as a communications transformer betweenelders and their family and friends, the concepts described herein arebroadly applicable to other social support networks caring for orlooking after one or more individuals that are cognitively or physicallyunable to use a computer system or simply disinclined to use a computersystem to send and receive email.

Furthermore, for sake of illustration, embodiments of the presentinvention are described in the context of a configuration of acommunication system in which there is a one-to-one-to-one relationshipbetween digital mailbox appliances, elders, and caregroups and messagesare exchanged among the elder associated with a particular digitalmailbox appliance and the corresponding caregroup members. However, itis contemplated that multiple individuals, such as an elder dyad (sayman and wife), could share a digital mailbox appliance and caregroup.Additionally, digital mailbox appliance to digital mailbox appliancemessages may be sent in scenarios in which an elder using one digitalmailbox appliance is a member of the caregroup of another elder usinganother digital mailbox appliance.

In one embodiment, elders 235 and 236 are able to participate inexchanges of messages with their families and friends via digitalmailbox appliances 240 and 241 using familiar paper-basedcommunications. The digital mailbox appliances 240 and 241 preferablyreside in the elders' residence and connect to the communication serviceprovider 215 via a residential phone line. According to one embodimentthe digital mailbox appliances 240 and 241 comprise multi-function photoquality printers (e.g., color or grayscale, inkjet or laser) withflatbed scanners and modems and are operated by local softwareconfigured and managed remotely by the communication service provider215. To accommodate single phone line residences, the digital mailboxappliances 240 and 241 may be specifically designed to effectively sharea single phone line with the elders' normal phone usage. In alternativeembodiments, the digital mailbox appliances 240 and 241 may beconfigured to interface with the communication service provider throughdigital subscriber line (DSL) service, cable modem, integrated servicesdigital network (ISDN) service, or other broadband or narrow bandservice. In alternative embodiments, the digital mailbox appliances 240and 241 may include one or more other forms of output devices inaddition to or instead of a printer, such as a video monitor or atext-to-speech conversion apparatus.

In the present example, elders 235 and 236 represent individualsparticipating in and having access to a communication service providedby the communication service provider 215. While the participants orusers of the digital mailbox appliances, e.g., elders 235 and 236, arethe focus of the communication service, typically, the subscriber to thecommunication service (i.e., the payer) is one or more members of aparticipant's caregroup.

The communication service may include communications transformation andmanagement services to facilitate electronic communications among theparticipants and their social support networks. For example, asdescribed in further detail below, members of the elders' social supportnetworks may access and use tools and templates for formatting andcreating various types of digital gifts and for creating collaborativepublications for the elders 235 and 236.

According to the present example, the communication service provider 215comprises automated components 220 and a central database 217. Automatedcomponents 220 may include multiple websites supporting family members,customer service operations for the communication service provider 215,research team service tools, coaching and communications managementsystems and tools, mailbox configuration management systems, publicationand delivery systems, email services customized to caregroup managementand digital mailbox appliance publication services, etc. The centraldatabase 217 is a central repository for all systems programs andmanages data on caregroups, elders, individual members, family photos,digital gifts and their component parts, specific delivery informationfor each communication, digital mailbox log histories, configurationinformation, etc. Further details regarding the hardware and softwareinfrastructure of an exemplary communication service provider areprovided below.

Services 225 may represent pre-screened service providers selected tomeet various needs of the subscriber base (e.g., digital mailboxappliance users) of the communication service provider 215.

In one embodiment, a unique identifier is assigned to each digitalmailbox appliance that is permanently stored in a non-volatile memory ofthe digital mailbox appliance. This digital mailbox appliance identifiermay be used for initial connection and registration of the end user,e.g., elder, into their supporting VPN. The digital mailbox applianceidentifier may also be used to validate the digital mailbox applianceeach time it attempts to connects to the communication service provider215. Further, the identifier permits the elder to move their digitalmailbox appliance to a new location (e.g., a convalescent home, arelative's home, etc.) and maintain seamless service. The digitalmailbox appliance identifier may also be used by the communicationservice provider 215 to facilitate interpretation of problem reports,logged events, etc.

FIG. 2B is a block diagram conceptually illustrating various collectionsof functionality packages 240-243 and their relation to thecommunication system platform 250 according to one embodiment of thepresent invention. In the example depicted, the communication systemplatform 250 includes a unified relational database 251, the digitalmailbox appliances associated with particular elder(s) and correspondingcaregroup, a publication and distribution server, customer servicepersonnel, and basic web and email services.

In the present example, for purposes of explanation, the digital mailboxservice is described as a number of functionality packages 240-243. Eachfunctionality package 240-243 interacts with the unified relationaldatabase 251 of the communication service platform. These functionalitypackages 240-243 provide services variously to family members, elders,communication service provider personnel and ex-officio caregroupmembers. The services provided typically have some automated components,some specialized website elements for family members and/or customersupport personnel of the communication service provider, as well as somespecialized elements of the unified relational database 251. Somesoftware and system components are common to more than one functionalitypackage. For example, digital mailbox logging may be used by several ofthe functionality packages in slightly different ways. Similarly, anemail parsing component may be utilized by multiple functionalitypackages.

According to one embodiment, a family website functionality package 240is unique for each caregroup and thereby supports individual family VPNsinto which members login. Because the digital mailbox appliances areassociated with and embedded in a family VPN, the communication serviceprovider is able to prevent SPAM and viruses from invading the elder'senvironment. While, due to the appliance environment, elders are largelyimmune to viruses, the communication service provider may whitelist(e.g., expressly define) all potential senders for the elder andautomatically filter all deliveries for viruses. According to oneembodiment, whitelist-based filtering involves creating a list ofaddresses of people that are authorized to send communications to theuser of the digital mailbox appliance and caregroup members andfiltering communications that are not on the authorized list. Meanwhile,because all web pages delivered to the elder go through custom renderingengines and because the digital mailbox appliance is not a standard PCusing a standard operating system, worms are prevented from accessingthe elder's side of the communication system.

The primary purpose of the family website service is to facilitatecommunication between family members and the target elder(s). The familywebsite functionality package 240 interacts with a distribution server(not shown) of the communication system platform to deliver familycommunications to the elder's digital mailbox appliance. The familywebsite functionality package 240 also facilitates the creation ofcommunications by providing various digital gift editors that simplifythe task of customization and personalization, suggesting ready madedigital gifts, and allowing members to view what other members have sentto the elder.

A return loop functionality package 241 manages traffic sent from thedigital mailbox appliances. Missives received from a digital mailboxappliance are typically originated by the elder. However, it iscontemplated that various support and service personnel working in theelder's environment may occasionally send communications via the elder'sdigital mailbox appliance. According to one embodiment, the return loopfunctionality package 241 includes dispatcher workbench websites forboth family dispatcher volunteers and customer service personnel of thecommunication service provider. Further discussion of manual andautomated dispatching of traffic sent from digital mailbox appliances isprovided below.

A dashboard and coaching functionality package 242 performscommunications assessment, monitoring, and provides the coachingenvironment used to influence and manage electronic familycommunications to and from the elder through the communication systemplatform 250. The dashboard and coaching functionality package 242 mayinclude various monitoring charts, tables, and instruments describedfurther below. The dashboard and coaching functionality package 242 mayalso provide a collection of coaching editors to help administratingcaregiver(s) in creating and sending coaching messages (also called“prompts”) to other caregroup members and/or the target elder(s).

A customer service functionality package 243 serves as an access pointfor customer support personnel of the communication service provider.The customer service functionality package 243 may also provide a rangeof traditional services to the communication service platform 250, otherservices, or other of the functionality packages 240-242. For example,in one embodiment, one or more of online (or phone) purchase andregistration, testing, responding to bugs, recovering data, identifyingthe frequency of problems, and repairing communications flow problemsmay be supported via the customer service functionality package 243.

Additional custom interfaces (not shown) for services can also beprovided to restricted sets of the database permitting ex-officiomembership (as granted by the family) to home care agencies, geriatricconsultants, assisted living personnel, support groups, etc.

One or more research service interface functionality packages (notshown) may also be provided. Such specialized service interfaces may beused to support specific scientific research projects funded by thegovernment or foundations. The various different research serviceinterface functionality packages may create specialized links into theVPNs associated with families supporting elders in various circumstances(e.g. Alzheimer's dyads, elder alone, assisted living, etc.). Theinterfaces may limit access in accordance with the correspondingresearch plan. For example, some interfaces may allow access to detaileddata on a subset of the caregroups represented within the communicationservice provider's subscriber base while limiting access to statisticaldata regarding other caregroups.

A digital mailbox operation and management functionality package (notshown) may serve as a network operations center (NOC) for thecommunication service provider's collection of VPNs. According to oneembodiment, the digital mailbox operation and management functionalitypackage may include web-based tools for the communication serviceprovider's customer service personnel and various software programs toremotely monitor and/or manage the digital mailbox appliances' (inklevels, logging, mailbox behavior configuration, software updates,heartbeat, error and error recovery . . . etc.). The digital mailboxoperation and management functionality package also includes softwarecomponents that support final stage publication and delivery of familydigital gifts and missives originated by the elder.

FIG. 3A and FIG. 3B illustrate before and after communication flows,respectively, among a social support network based on the findings ofvarious pilot studies. While communications are complex and varied(there is no single channel, there is no simple uniform effect onparticipants), increases in communication between the elder and familymembers, as shown by heavier arrows, and also increased ornewly-established communication among other family members have beenobserved. Notably, communications increases to and from the elderthrough the communication service provider as well as outside theservice (e.g., phone). Communication also increases among members of thesocial support network (again within the service provided by thecommunication service provider as well as outside). Within the contextof family communications sending a communication often provokes one ormore responses, which in turn create more responses establishing complexdialogs binding families into a shared experience.

FIG. 4 is a block diagram conceptually illustrating a communicationarchitecture of a communication system platform 400 according to oneembodiment of the present invention. This highly simplified descriptionof major conceptual blocks is intended primarily to illustrate the majorflows of information from the caregroup members, e.g., family andfriends 420, using various appliances to the elder 401 (through theelder's digital mailbox appliance 410) with the communication serviceprovider and other service personal participating as necessary.

In this simplified illustration, the communication system platform 400provides interfaces for the elder 401 via digital mailbox appliance 410,family and friends 420 of the elder 401, and communication serviceprovider services 440. In this example, the communication serviceprovider may provide various services, such as monitoring, tracking, andanalysis of family communications, to support the administratingcaregiver in his/her coaching role.

Given the personal and potentially sensitive nature of communicationsthat are contemplated to be exchanged through the communication systemplatform 400, participants should expect any entity serving in thecapacity of a communication service provider to implement and enforcestrict privacy policies. This is particularly important in the contextof communications between healthcare professionals and the elder, theprimary resident caregiver or the administrative caregiver in view ofvarious national and state standards to protect the privacy of personalhealth information, such as the Health Insurance Portability andAccountability Act (HIPAA).

In one embodiment the closed nature of the communication service seeksto protect families and their elders from the familiar risks of Internetcommunication including spam, viruses, spyware, unsolicited commercialoffers, and more. While the communication service provider may collectpersonal information during the course of use by members of caregroupsand the targets of the caregroups with the goal of establishing andmaintaining caregroup VPNs, this information may be used to protect andempower the participants in various ways, including limiting access tocaregroup VPNs, allowing families to share the caregiving load, andprohibiting advertising and/or solicitation by external commercialentities. In one embodiment, admission to caregroups may be limited tofamily, friends, and other approved caregivers and/or service providersdesignated by the elder and the family. Furthermore, privileges withinthe caregroup may be defined by the elder and/or an administratingcaregiver. In one embodiment, an ex-officio healthcare provider maycollect information on a participant patient's health and send privatedigital gifts to such patient. By way of the closed communicationservice enabling wide, but exclusive, membership in an elder's caregroupand by aggregating information about the types and frequency ofcommunication within these groups, families are empowered to share thecaregiving load and are able to work together in new and more efficient,effective ways to support their elders.

According to the present example, the communication system platform 400provides a communications transformer that emphasizes familiar paperoutput for elders and leverages the increasing use of computertechnology by their families and friends. In this manner, a solution isprovided to address the disparate technologies used for communicationand styles of communication among various members of a family supportnetwork. Each member of the family support network may use a systemadapted to their individual lifestyles. As will be described furtherbelow, the communication system platform 400 exploits the power ofcollaboration and community to share the load of creating personalizedcommunications for aging loved ones.

The communication system platform 400 includes a web server 420, adistribution server 430, and a central service database 450.Participating family members may send emails, digital gifts, or cameraphone messages to the elder 401 through traditional email and/or the webserver 420, which hosts the family VPN websites. Communications, such asemail, Multimedia Messaging Service (MMS) messages from camera phones,and digital gifts are stored in the central service database 450 andforwarded to the distribution server 430 for processing into anappropriate printable format and stored for delivery to the elder'sdigital mailbox appliance 410 by the communication service providerservices 440, which delivery may be automated or may include manualintervention by a customer service representative or an administratingcaregiver as described further below.

According to one embodiment, the digital mailbox appliance 410, whichwould typically reside in the elders' home, has two functions. Itprovides for unattended printing (e.g., periodic digital publications towhich various members of the caregroup have contributed) and permits theelder to scan self addressing content for delivery as email to one ormore of the members of her caregroup.

According to one embodiment, the quality of the hardcopy output of thedigital mailbox appliance 410 and the color scan input is such thatcolor snapshots can readily be incorporated into the digital gifts sentto or from the elder 401, respectively.

In a preferred embodiment, the digital mailbox appliance 410 comprises anew multi-function device priced at about $250 (or less) retail andprovides ≧300 dpi color printing, flatbed scanning, scheduled polling, alarge status display, a single-button control panel, a hidden auxiliarycontrol panel, a high-output speaker, a proprietary communicationsinterface, physical forms storage, remote connectivity over an analogphone line, as well as remote monitoring and management.

Design trade-offs for a digital mailbox appliance 410 targeted forelders and similarly situated individuals are atypical. For example,print speed is not perceived to be a key issue. However, the speed ofthe communications link is perceived to be relatively important. In oneembodiment, personal printing features, such as low-cost inkjettechnology are mixed with enterprise features, such as remote monitoringand management. According to one embodiment, copying will not be offereddespite the presence of all of the necessary hardware to provide copyingcapabilities. In one embodiment, the digital mailbox appliance 410includes no standard computer interface and functions solely as astandalone appliance rather than as a computer peripheral.

According to various embodiments of the present invention, instead ofthe frustration of a personal computer, a digital mailbox applianceprovides to elders or other digital mailbox appliance users the welcomefamiliarity of simple paper-based communications. The elders' digitalmail arrives automatically. Deliveries to the digital mailbox appliance410 may be configured to occur every day on a pre-set schedule. To senda handwritten note seniors press a single button to initiate scanningand delivery of the note. Various benefits of the digital mailboxappliance 410 include its simplicity, security, robustness,low-maintenance, remote supportability by the family or communicationservice provider personnel. Additionally, paper-based communicationshaving configurable font size tailored to the recipient accommodatesvisual impairments. Because the printed output can be customized on thelevel of an individual digital mailbox user numerous needs andpreferences can be accommodated (consider color-blindness, contrastrequirements, . . . etc.).

Note that in this description, in order to facilitate explanation, theweb server 420, distribution server 430, central service database 450and communication service provider services 440 are generally discussedas if they each reside on or are part of a single computer system.However, it is contemplated that such servers, databases and servicesmay each actually comprise multiple physical and/or logical devicesconnected in a distributed architecture. Additionally, in alternativeembodiments, the functions performed and the data stored may beconsolidated and/or distributed differently than as described.

FIG. 5 is an example of a computer system 500 with which embodiments ofthe present invention may be utilized. The computer system 500 mayrepresent a web server, presentation server, a distribution serverand/or other computer systems involved in the communication systemplatform. According to FIG. 5, the computer system 500 includes one ormore processors 505, one or more communication ports 510, main memory515, read only memory 520, mass storage 525, a bus 530, and removablestorage media 540.

The processor(s) 505 may be Intel® Itanium® or Itanium 2® processor(s),AMD® Opteron® or Athlon MP® processor(s) or other processors known inthe art. Communication port(s) 510 can be any of an RS-232 port for usewith a modem based dialup connection, a 10/100 Ethernet port, or aGigabit port using copper or fiber. Communication port(s) 510 may bechosen depending on the network environment in which the computer system500 operates, such as the Internet, a Local Area Network (LAN), WideArea Network (WAN), or any network to which the computer system 500connects.

Main memory 515 may be Random Access Memory (RAM), or any other dynamicstorage device(s) commonly known in the art.

Read only memory 520 may be any static storage device(s) such asProgrammable Read Only Memory (PROM) chips for storing staticinformation such as instructions for processors 505.

Mass storage 525 may be used to store information and instructions. Forexample, hard disks such as the Adaptec® family of SCSI drives, anoptical disc, an array of disks such as RAID, such as the Adaptec familyof RAID drives, or any other mass storage devices may be used.

Bus 530 communicatively couples processor(s) 505 with the other memory,storage and communication blocks. Bus 530 may be a PCI/PCI-X or SCSIbased system bus depending on the storage devices used.

Optional removable storage media 540 may be any kind of externalhard-drives, floppy drives, IOMEGA® Zip Drives, Compact Disc—Read OnlyMemory (CD-ROM), Compact Disc—Re-Writable (CD-RW), Digital VideoDisk—Read Only Memory (DVD-ROM).

FIG. 6A illustrates a member login user interface screen 600 accordingto one embodiment of the present invention. In this example depicted, ifan individual is a member of only a single caregroup, the member loginsto the caregroup VPN by entering his/her email address into an emailaddress field 605 and entering his/her password into a password field610 of the member login user interface screen 600. If, however, theindividual is a member of multiple caregroups, then a caregroupselection user interface screen, such as that illustrated in FIG. 6B maybe used to solicit information regarding the desired caregroup VPN intowhich the member would like to login.

FIG. 6B illustrates a caregroup selection user interface screenaccording to one embodiment of the present invention in which the useris a member of multiple caregroups. According to one embodiment of thepresent invention, each digital mailbox appliance has one and only onecaregroup. Caregroup members are typically family and friends of theelder using the digital mailbox appliance. After logging in via a memberlogin user interface screen, such as that illustrated in FIG. 6A, if themember participates in more than one caregroup they are asked to selectthe caregroup VPN into which they want to be placed.

FIG. 7 illustrates a caregroup home page user interface screen 700according to one embodiment of the present invention. According to oneembodiment, once logged in members work within a website thatencapsulates the VPN of the social support network of a particular elderwith a digital mailbox appliance. In the present example, the home pageincludes a list 710 of various upcoming events, such as birth dates ofvarious family members. The home page also includes an area 720depicting thumbnail representations of recent “Daily Deliveries” therebyallowing members to review digital gifts that have been sent to theelder.

FIG. 8 illustrates a member registration user interface screen 800according to one embodiment of the present invention used by caregroupadministrators to register a new member to their caregroup. In oneembodiment, an administrating caregiver is provided with the ability toregister new caregroup members. The administrating caregiver(s) haveadministrative privileges and may therefore add members through a pop-upeditor in the website as shown by member registration user interfacescreen 850.

If the communication service provider already has information regardingthe member by way of the member being part of another caregroup, forexample, then the member is simply added to this caregroup with alltheir existing directory information. If not, additional initialinformation is requested. According to one embodiment, new members aresent an email requesting that they opt-in and directing them to aregistration page and further training (as appropriate).

In the present example, to add a new member to a family support network,the administrating caregiver navigates to a member directory userinterface screen 800, selects the “Add Member” link, and then enters thenew member information on the member registration user interface screen850.

In alternative embodiments, phone to a customer service representativeof the communications service provider or to an automated telephonesystem or other web interfaces may be provided to the administratingcaregiver to add new caregroup members. Furthermore, administratingcaregivers may act as recruiters and provide a list of desired membersto the communication service provider. Subsequently, the communicationservice provider may send an email introduction to each of theindividuals listed by the administrating caregiver and allow theindividual family members to opt-in.

FIG. 9 is a software architecture block diagram conceptuallyillustrating application-level software components of a distributionserver 920, a web server 910, and internal components of a digitalmailbox appliance 900 according to one embodiment of the presentinvention.

According to the software architecture depicted, the web server 910includes a publication scheduler 911 that gathers up digital gifts andpublishes them to the delivery generator 926 based on a scheduleconfigurable by the administrating caregiver(s), a centralized database912 holding all caregroup data, and a web server 913 providing the website services to the caregroup members, to the customer service groups,to the digital mailbox network operators and managers, and to theresearch team running clinical trials.

In the example depicted, the distribution server 920 includes a logupload server 921, a configuration server 922, a scan upload server 923,a time server 924 a print job server 925, an edition generator 926 andan email processor 927.

According to one embodiment, communications to and from any digitalmailbox appliance 900 occurs only when initiated by the digital mailboxappliance 900. The scheduler 915 notifies the task manager 916 whichlaunches the modem controller 917 which establishes contact with thedistribution server 920. An alternative method of connection occurs whenthe user puts an item (form, reply requested, paper clipping, anything .. . ) on the scanner and presses the send button (part of the Userinterface 907). The send button initiates execution of a scan throughthe scan controller 906 which puts a compressed digital representationof an image of the item on the scan queue 903 and then establishes aconnection to the distribution server 920 by notifying the task manager916 which directs the modem controller 917.

Once connection is established a number of communications processes takeplace between elements of the distribution server 920 and the digitalmailbox appliance 900. In one embodiment, the processes that occurduring a connection fall into three major categories: 1) delivery ofprint jobs to the digital mailbox appliance 900, receipt of the scanjobs from the digital mailbox appliance 900, and remote maintenance ofthe digital mailbox appliance 900.

In one embodiment, remote maintenance consists of 1) tracking loggedmailbox events (e.g., print and scan events, problem occurrences,program operation histories, heartbeat history, . . . etc.), 2) timesynchronization, 3) configuration update (e.g. phone numbers for themodem to call under various conditions, contact schedules, softwareversion information), 4) digital mailbox status information (e.g., inklevels) and 5) applications software updates.

The log upload server 921 collects logging reports from each digitalmailbox appliance logger 901 and records them in the database 912appropriately indexed to the corresponding digital mailbox appliance 900(using the mailbox's unique ID, for example). Recognized digital mailboxappliance errors are specially noted and appropriate alerts are sent torepresentatives of the communications service provider.

The configuration server 922 maintains and transmits configurationchanges to the configuration manager 902 of each digital mailboxappliance 900 (recognized by its unique ID, for example). Configurationchanges (such as the scheduled time of printing the elder's regulardelivery) from a variety of sources (such as the administratingcaregiver through the caregroup's VPN) are registered in the database912 and updated into the configuration manager 902 with each contactwith the appropriate digital mailbox appliance 900.

According to one embodiment, scans are initiated by the elder pressing asingle “Send” button. The scan controller 906 launches a scan process,compresses the scan into JPEG format and places the scan in the localscan queue 903. The scan queue 903 holds the image(s) accumulated untilthey are transferred to the scan upload server 923. The scan uploadserver 923 gathers scans sent from each digital mailbox appliance 900and registers the scans in the database 912. These scans are thendelivered to the intended recipient(s) via automated dispatch processesthat are launched as described below.

The time server 924 updates the local clocks of each digital mailboxappliance 900. According to one embodiment, each time a digital mailboxappliance 900 contacts the distribution server 920, the time server 924updates the digital mailbox appliance's local clock through the TimeSynchronization process 904. In alternative embodiments, in which thedigital mailbox appliance 900 is configured to receive calls, the timeserver 924 may periodically push time updates to the digital mailboxappliance 900. In other embodiment, the time server 924 may provide timeinformation to the digital mailbox appliance 900 responsive to explicitrequests by a digital mailbox appliance.

The print job server 925 collects and sends print jobs to theappropriate digital mailbox appliance 900. According to one embodiment,each time a digital mailbox appliance 900 contacts the distributionserver 920, the print job server 925 updates the digital mailboxappliance's local print queue 905.

The delivery generator 926 periodically creates a print job for eachdigital mailbox appliance. The print job is formatted as specified bypreferences stored in the database 912 and includes each of the digitalgifts defined in the database 912 that are scheduled for the nextdelivery to the digital mailbox appliance 900. According to oneembodiment, the publication of the caregroup's digital gifts, the timingof publication, the timing of scheduled contact from the digital mailboxappliance 900 and the timing of printing at the digital mailboxappliance 900 is set by the administrating caregiver(s).

At the time schedule for delivery, the scheduler 915 notifies the taskmanager 916 which launches the print controller 908 to print the printjobs on the print queue 905. According to one embodiment, some printjobs are specially marked for immediate delivery. Such print jobs areprinted at the first available opportunity, such as (1) upon completionof the next send operation, (2) upon completion of the digital mailboxappliance's initial connection after being powered up, or (3) at thenext scheduled delivery time(s), whichever is first.

The email processor 927 provides traditional email services and parsesand manages email transmissions, Short Message Service (SMS) messages,instant messages via ICQ, AIM, MSN, Jabber, Yahoo, Gadu-Gadu, Tlen,Netsend and other IM protocols, and/or MMS messages. Such transmissionsand messages may be translated into digital gifts and stored in thedatabase 912 for later batch delivery with a daily delivery, forexample. Email messages are also transmitted to members of caregroups onbehalf of a user of a digital mailbox appliance, for example when selfaddressing messages are received and parsed from the digital mailboxappliance. According to one embodiment, handwritten missives originatedat a digital mailbox appliance are transmitted by email as attachedimages or embedded images. Alternatively, a Universal Resource Locator(URL) or other hypertext link may be transmitted to the recipient(s) toallow more efficient delivery and provide the recipient control overwhen the images are retrieved and displayed.

FIG. 10 is a flow diagram illustrating a method of performing contentderived addressing according to one embodiment of the present invention.This process begins as items are scanned into the digital mailboxappliance by the user of the digital mailbox appliance. In oneembodiment, an elder may initiate delivery of a correspondence to amember of his/her caregroup by simply placing it on a flat scanner bedand pressing a single button. No typing or dialing is required.Additionally, the elder need not be aware of the individual intendedrecipients' preferred electronic communications delivery mechanism(e.g., email device, facsimile, digital mailbox appliance, computersystem, wireless handheld, etc.) or their “addresses” (e.g., emailaddress, fax number, unique digital mailbox appliance ID, cell phonenumber, IM username, etc.).

At block 1010, responsive to an indication that a page of acorrespondence is present on the flatbed scanner, the digital mailboxappliance “scans” the page to create a digitized version in the form ofan image file having a particular graphic, raster or image file format,e.g., Joint Photographic Experts Group (JPEG), JPEF File InterchangeFormat (JFIF), Tag(ged) Image File Format (TIFF), PostScript,Encapsulated PostScript (EPS), Computer Graphics Metafile (CGM), PICT,Graphics Interchange Format (GIF), Bitmap (BMP), Portable DocumentFormat (PDF) or the like.

At block 1020, the digital mailbox appliance may perform various limitedlocal processing, such as scan conversion, storing of the scan, errorrecognition and reporting, time stamping and logging the scan, localtransaction processing, buffering multiple scans, contacting thedistribution server of the communication service provider and forwardingthe scan(s) and re-tuning scan parameters of the digital mailboxappliance flatbed scanner as appropriate. According to one embodiment,the scan resolution, file type and compression specification are managedas a part of the digital mailbox appliance configuration definition andare updateable from the distribution server.

According to one embodiment, when the scan of the document by thedigital mailbox appliance scanner is complete, the raw bitmap isconverted into a JPEG image file that is then saved in an internalupload message queue in a file system local to the digital mailboxappliance. This file system may be either in persistent (non-volatile)memory or RAM, depending upon how the digital mailbox appliance isconfigured. If the local file system is in persistent memory, then ifthere is a power failure, the document will not be lost and may be sentupon restoration of power.

According to one embodiment, the digital mailbox appliance may initiatea connection with the communication service provider via an internalmodem concurrently with the initiation of a scan. Once the digitalmailbox appliance has connected to the Internet, it may look for theexistence of any scanned images in its internal upload message queue.The digital mailbox appliance may then upload any files that are in theupload queue. Each time the digital mailbox appliance successfullyuploads a file to the distribution server, it may delete the file fromthe upload queue.

In one embodiment, if there are no files in the upload queue once themodem has connected. If the scanner is still in the process of scanning,the digital mailbox appliance may remain connected to the Internet, waituntil the scan is complete, and then upload the scanned message to thedistribution server. This process may be repeated until the upload queueis empty and the scanner is no longer scanning. In this manner, theelder may scan multiple documents during one connected session to theInternet.

According to one embodiment of the present invention, various locallydetectable errors, such as recognition of blank pages, empty scanner,backside-down pages (i.e., form facing away from scanner as determinedby bleed through sensing), duplicate pages, etc., may be resolvedlocally or reported to the elder (e.g., in the form of an errornotification, such as a buzz, screen update, etc.).

According to one embodiment, custom forms are provided to the elder foruse in generating correspondence. “Decorations” on any given form may bedesigned to have a minimum scan compression size (e.g., on the order of40 K bytes to 150 K bytes) that exceed a typical blank page (e.g., scansize of between approximately 5 K bytes and approximately 15 K bytes) orupside-down scan. Pages scanned upside-down typically result in a largerscan size (e.g., >=15 K bytes, but less than 40 K bytes) than blankpages as a result of bleed through. In this manner, a simple evaluationof the size of the resulting scan may be performed to categorize thescan as one resulting from a legitimate and acceptable page ofcorrespondence, an empty scanner, a blank page, or an upside-down page.

At block 1030, the distribution server performs processing of sets ofscan(s) (i.e., one or more uploaded messages originated by the digitalmailbox appliance). According to one embodiment, once a scanned image isuploaded, it is saved to the central service database of thecommunication service provider within a scan data structure along withadditional data extracted from the scan (e.g., scanned image file name,date and time information, sizing, etc.) and a scan. For purposes offacilitating coaching by the administrative caregiver, for example, thescan may also be registered in the central service database as havingbeen originated by the particular digital mailbox appliance using theunique digital mailbox ID, for example.

After the set of scans has been successfully stored in the centralservice database, a notification may be sent to the automated dispatchprocessing to initiate the automated dispatch processing of block 1040where automated dispatching software may examine the set of scans foritem identification marks, such as a barcode, a MaxiCode (i.e., a twodimensional barcode used by United Parcel Service (UPS) on packing slipsfor package sorting and addressing), or other identification markssufficiently identifiable by linear barcode scanning, 2D barcodescanning or Optical Character Recognition (OCR) techniques, tofacilitate automated dispatch of the set of scan(s) as described furtherbelow.

At decision block 1045, a determination is made whether automateddispatch was successful. If automated dispatch is successful and aparticular set of scans is capable of automated dispatch without manualintervention, then processing continues with block 1070. Otherwise,processing branches to block 1050.

According to various embodiments, one or more assisted dispatchprocesses may be provided as a fallback strategy if automated dispatchprocessing cannot be successfully completed. In one embodiment, partialprocessing by the automated dispatch process is preserved and suppliedto the assisted dispatch processes to minimize human time and effort.

In one embodiment, if a set of scans cannot be automatically dispatchedby the automated dispatch processing of block 1040, the set of scans areplaced on an inbound queue for family dispatch processing. When sets ofscans are placed on the inbound queue for family dispatch processing,they may be time stamped to ensure timely handling. If a time thresholdis exceeded for a particular set of scans, they may be dequeued andplaced on an inbound queue for dispatch processing by the communicationservice provider.

At block 1050, a family dispatch process is performed. At this point inthe distribution cycle, image, core data (from, date/time, sizing, . . .etc.), and partial automated dispatch processing (e.g., formidentification, resolution of zero or more addressee(s), componentparsing (subimage, original), etc.) has already been completed.According to one embodiment, the family dispatch process comprises amanual process of determining the intended recipient(s) of the set ofscans.

The responsibility for performing the family dispatch process may beshared or rotated among individuals in the caregroup or may be performedby the administrating caregiver. Regardless, the individual(s) servingin the role of family dispatcher is preferably both capable ofinterpreting the desires of the elder based on familiarity and specificknowledge and motivated to serve the elder.

At decision block 1055, a determination is made whether family dispatchwas successful. If family dispatch is successful, meaning the familydispatcher has handled and a particular set of scans within anacceptable timeframe by identifying one or more members of the caregroupas intended recipients of the set of scans, and marking the set of scansfor delivery to the intended recipients (e.g., by including appropriateaddress information in a distribution list associated with the set ofscans), then the distribution of the set of scans continues with block1070. Otherwise, processing branches to block 1060. The familydispatcher may also manually pass the set of scans and current dispatchstate on to the communication service provider dispatcher. Forwarding tothe communication service provider dispatcher may also be automated witha vacation setting, for example.

At block 1060, a communication service provider dispatch process isperformed. According to one embodiment, the communication serviceprovider dispatch process comprises a manual process of determining theintended recipient(s) of the set of scans and tagging, labeling orotherwise marking the set of scans accordingly.

At decision block 1065, a determination is made whether communicationservice provider dispatch was successful. Assuming the communicationservice provider dispatcher is capable of identifying one or moremembers of the caregroup as intended recipients of the set of scans,then the dispatcher fills in the proper address information for the oneor more addressees and the distribution of the set of scans continueswith block 1070. Otherwise, at block 1080, the intended addressee(s) maybe solicited from the elder via in-band or out of band communications.

According to one embodiment, a workbench application and tools areprovided to the dispatchers (e.g., the family dispatcher(s) and/or thecommunication service provider dispatcher(s)) to facilitate review andanalysis of incoming sets of scans for dispatch. For example, a tool forquick orientation flipping may be provided, such as a website “reader”with one click rotation. As a last resort, a family or communicationservice provider dispatcher may initiate a query to the elder through acommunication delivered to the elder's digital mailbox appliance, byphone, or otherwise.

FIG. 11 illustrates a sample completed routing form 1100 and resultingemail message 1150 delivered to the addressee according to oneembodiment of the present invention. According to the present example,the user of the digital mailbox appliance is supplied with pre-formattedrouting forms that allow the user to “address” correspondence by simplychecking off address information on a routing form. The pre-formattedrouting forms may be periodically mailed to the digital mailbox user orprinted on his/her digital mailbox appliance.

The routing form 1100 of the present example includes a formidentification barcode 1110 and various information segments, such as anaddressing sector 1120 and a handwriting sector 1130. As will bedescribed further below, based upon the content and location of thevarious sectors as identified by the form type, the forms may be parsedby image processing routines running on the distribution server.

In the example depicted, the user of the digital mailbox appliance hasmarked one of the members 1121 of his/her caregroup as the intendedrecipient of a brief handwritten message provided in the handwritingsector 1130. If automated dispatch is desired, the intended addressee1121 may be determined by applying various image processing algorithmsto the address sector 1120 as described further below. For example, inone embodiment, an original version of the address sector 1120 of therouting form 1100 may be compared to the completed (marked) version ofthe address sector 1120 of the routing form 1100 to determine whetherone or more addressees have been marked.

According to alternative embodiments, the user of the digital mailboxappliance may be provided with preprinted addressee identificationlabels containing the names and/or photos of the members of the user'scaregroup and identification marks, such as a barcode, data matrix,semicode, MaxiCode, or the like, uniquely associated with individualmembers of the caregroup. The elder might be encouraged to think of themas addressing “stamps.” The user then “addresses” correspondence priorto scanning by affixing one or more preprinted labels in a specifiedarea of the routing form. Identification labels may also be created torepresent certain subgroups of the caregroup members, such as grandkids,nieces, nephews, children, and everyone. In this manner, the user of thedigital mailbox appliance may easily direct correspondence toappropriate subgroups of his/her caregroup when appropriate. Accordingto another alternative embodiment, the user has reusable addressingcard(s) that they lay down on the flatbed along with the correspondence,photo or clippings they intend to send. Addressing card variationsinclude, (1) a “to card” for each possible recipient (and one foreverybody—the aggregate) and (2) a single plasticized card with checkboxes for the desired addressee(s).

Yet another way to simplify addressing of correspondence for users ofdigital mailbox appliances is to provide preprinted forms that arerecognized by the communication service provider as being destined to aspecific member of the caregroup or a specific subgroup. Again,identification marks may be used, such as barcodes and the like tocommunicate the information regarding the intended addressee(s), but inthis case the identification marks would be part of the routing formrather than supplied as preprinted labels. According to anotherembodiment, the digital mailbox appliance user uses any previouslyreceived message or digital gift from a caregroup member as a routingform to identify that caregroup member as the intended addressee, jots anote (or not) and then sends the optionally annotated previouslyreceived message or digital gift optionally followed by photos,clippings, or any number of additional pages. All the scans are gatheredup by the communication service provider and delivered to the originalsender of the message or digital gift. Thus, an elder can send off aquick thank you note on any digital gift (or even items from thecommunication service provider).

In one embodiment, in order to send an electronic communication to theindicated addressee(s), the digital mailbox appliance user places thecompleted routing form on the flatbed scanner of the digital mailboxappliance and presses the “Send” button. In the present example, theresult of the user sending the routing form 1100 is delivery of message1150 to June. Upon receiving the scanned image of the routing form 1100,the communication service provider's infrastructure takes care of therest, as described below, for example, by extracting the handwritingsector 1120 from the scanned image of the routing form 1100 andincluding the extracted image of the handwriting sector 1120 as aninline image within a standard email message. Alternatively, theextracted image may be sent as an attachment or a URL to the extractedimage may be sent.

FIG. 12 illustrates a sample completed return-reply requested form 1200that may be created and delivered to a digital mailbox applianceresponsive to a caregroup member request according to one embodiment ofthe present invention. According to the present example, a caregroupmember may provide a photo journal form 1200 to an elder and/or othermembers of the caregroup to allow reprints to be ordered of one or morephotos or allow the recipient(s) to vote for a favorite.

In this example, the photo journal form 1200 includes a formidentification barcode 1210 to allow the communication service providerto identify and parse the form, a photo sector 1220 depicting a photoand a corresponding selection sector 1230. In alternative embodiments,one or more pairs of photo sectors 1220 and selection sectors 1230 maybe include on a single form. In any event, the originator of thecompleted photo journal form 1200 has marked a “Hard Copy Please”selection from the check-off list to request a hard copy of the photodepicted in the photo sector 1220. Various alternative selections arecontemplated. For example, the digital mailbox appliance user, may beprovided with the option of having a digital version of the photo storedas an eCard image and/or in his/her photo shoebox for future use.

FIG. 13 illustrates another sample completed return-reply requested form1300 that may be created and delivered to a digital mailbox applianceresponsive to a caregroup member request according to one embodiment ofthe present invention. According to the present example, a caregroupmember may send a life harvest album form 1300 to an elder to solicitinput regarding one or more photos as part of a family or caregroupproject. The life harvest form 1300 includes a form identificationbarcode 1310 in one or more locations to allow the communication serviceprovider to identify and parse the form, a photo query sector 1320 whichmay include one or more photos for discussion and correspondinghandwritten response sectors 1330 for elder feedback.

FIG. 14 illustrates another sample completed routing form 1400 that maybe provided by the communication service provider to a digital mailboxappliance user and customized for the user according to one embodimentof the present invention. According to the present example, the routingform 1400 includes a form identification barcode 1410 in one or morelocations to allow the communication service provider to identify andparse the form, an addressing sector 1420, a handwriting sector 1430,and a check-box 1440 to indicate additional pages will follow.

In the example depicted, the user of the digital mailbox appliance hasspecified broadcast distribution of the written message in thehandwriting sector 1430 message by marking check-box 1421 in theaddressing sector 1420 corresponding to distribution to “everybody”listed in the addressing sector 1420. According to the present example,if the user of the digital mailbox appliance intended to scan additionalpages to be included as part of the distribution, then her/she wouldsimply mark check-box 1440. As described further below, multiple page orcontinuous communications may be recognized in various other ways.

FIG. 15 illustrates a sample coaching message 1500 and associated form1510 that may be directed to a digital mailbox appliance user accordingto one embodiment of the present invention. In the present example, acaregroup member, Mike, has sent coaching message 1500 containing asample Halloween eCard and directions to encouraging an elder, Gertrude,to send a Halloween card to the elder's nephews. The caregroup memberhas also provided the elder with an ecard selection form 1510 to furthersimplify the task.

FIG. 16 illustrates a sample completed ecard form 1600 originated at adigital mailbox appliance and a resulting ecard 1650 generatedresponsive thereto according to one embodiment of the present invention.In the present example, an elder, Gramps Ted, has completed ecard form1600 by marking a desired image 1621 in the selection sector 1620 andproviding a personalized message in the handwriting sector 1630. As willbe described further below, by simply checking boxes a user of a digitalmailbox is able to specify the composition of a customized eCard, suchas the resulting eCard 1650. In the present example, responsive toreceipt and processing of eCard form 1600 by the communication serviceprovider, the resulting eCard 1650 may be composed by retrieving thedesired image 1621 from the central service database and combining theretrieved image with handwritten materials extracted from handwritingsector 1630 of eCard form 1600.

While the examples of FIGS. 15 and 16 are explained with reference to amanually initiated coaching message and a specific holiday, similarcoaching messages may be automatically generated for various otherholidays or family “days of note,” such as birthdays, anniversaries, orthe like, such as any condition when a traditional greeting card wouldbe appropriate.

FIG. 17 is a flow diagram illustrating a method of performing automateddispatch according to one embodiment of the present invention. In thepresent example, responsive to a set of scans uploaded from a digitalmailbox appliance, the distribution server of the communication serviceprovider initiates image processing at block 1710 to identify the typeof predefined form employed for this particular missive. Typically, thefirst page of an elder missive will include form identification marksthat allows a determination to be made regarding which of a predefinedset of forms is represented by the first page of the elder missive. Forexample, in one embodiment, the form identification marks are a barcodethat is included on each form in the upper right-hand corner of the formand the lower left-hand corner of the form. Various other identificationmarks and locations may be employed. For example, barcodes (code 128,code 39, Interleaved, EAN, . . . etc), data matrix, MaxiCode, OCR (A orB) and other machine readable codes. Depending upon the particularimplementation, there are certain tradeoffs among identification markdensity, resolution, transmission time, softwareavailability/price/programmability, etc. that would typically beevaluated.

Certain simplifying assumptions made in the automated dispatchtechniques described below include an assumption that blank page, emptyscanner and backside-down page errors are resolved local to the digitalmailbox appliance or at least prior to execution of this automateddispatch processing. Additionally, it is assumed that certain physicalpage placement restrictions are implemented at the digital mailboxappliance resulting in only three possible orientations of a scannedversion of a form (i.e., rightside-up, upside-down and backside-down).Finally, it is assumed that the item or form identification marks areincluded at one or more predetermined locations on each type of form ofthe set of predetermined forms. According to one embodiment, thecommunication service provider may supply special paper for use with thedigital mailbox appliance to force a specific orientation in the flatbedscanner. For example, the bottom right hand corner of the supplied papermay be clipped off to match a feature of the flatbed scanner and/or theinput tray to require a specific orientation of the paper at scan time.

Given the above simplifying assumptions, the form recognition andidentification processing need only examine one or two general locationsof the scan (one assuming the form is rightside-up and one assuming theform is upside-down) for purposes of locating form identification marks.If a form identification mark, such as a MaxiCode barcode, is located,then the information conveyed thereby may then be used to retrieveinformation regarding the corresponding form type. For example, thecharacters of information represented by a barcode (e.g., the barcodevalue) may be used as part of a query to retrieve information from thecentral service database of the communication service provider.

If, at block 1710, no form identification marks are located, the formtype identification process has failed and further analysis is performedto determine if the current scan is a second or subsequent page of amultipage message. If form identification marks are located, however,then as a result of each value defining a specific form of a set ofpredefined forms, information regarding the characteristics of the formnow identified may be retrieved. As described above, each form type mayhave a set of defined form segments, such as zero or more addresssectors or areas, selection sectors or areas, and/or handwriting sectorsor areas. After having failed in determining the type of form or havingsucceeded in determining the type of form represented by the currentscan and retrieving information regarding the form's characteristics(e.g., the number, type and locations of the various included segments),automated dispatch processing continues with decision block 1720.

At decision block 1720, a determination is made regarding the successfulidentification of a form type associated with the current scan. If aform type was successfully identified in block 1710, then processingcontinues with block 1730; otherwise processing branches to decisionblock 1725.

At decision block 1725, it is known that no form identification markswere located within the current scan. In view of the simplifyingassumptions summarized above, it can be appropriately deduced thateither (1) the current scan “page” was intended by the originator to bepart of a continuing correspondence and should therefore should bedispatched in accordance with the prior scan page; or (2) the page ofcorrespondence represented by the current scan page did not employ arecognized form.

A determination is made at decision block 1725 whether the current scanis intended to be part of a continuing communication. According to oneembodiment of the invention, if additional scanned images are receivedwithin a predefined period of time of a prior scan, those images areassumed to be included with the previous image and are sent to therecipients identified in or associated with the previous image. Thecommunication service provider may infer that received scans are 2^(nd)or subsequent pages of a continuing communication (collectively orindividually “follow-on” pages) based on the timing of the scans and alack of identification markings barcode. In one embodiment, scans areconsidered follow-on pages only if they are originally scanned within ashort duration, e.g., seconds to minutes, after the 1st page form (e.g.,a routing form). The duration may be a configurable parameter set by thecommunication service provider and/or an administrating caregiver. Ifsubsequent scans have different recipient information, however, then theautomated dispatch process will treat such subsequent scans as a newmessage to be sent to a new set of recipients identifiable byinformation contained within such subsequent scans. In this manner, theelder is able to send multiple pages to a set of recipients withouthaving to identify the set of recipients on each page.

As described earlier, in alternative embodiments, the elder may check abox on the first page of a correspondence to indicate whether one ormore pages follow. Alternatively, a check box may be included onfollow-on form pages to allow them to be marked by the user of thedigital mailbox appliance as being associated with an earlier scanned“address” or routing page. Regardless of the mechanism or algorithm useto make the determination, if, at decision block 1725, it is determinedthe current scan is part of a continuing communication, then processingcontinues with block 1726. Otherwise, processing continues with block1755.

At block 1726, the current scan is marked as a follow-on page (e.g., a2^(nd) or subsequent page of a continuing communication). According toone embodiment, this marking process includes modifying informationstored in the corresponding scan data structure in the central servicedatabase. As discussed further below, the composition process notes theexistence of follow-on pages and appends them to the basic missive to beemailed to the addressee(s).

At block 1755, the current scan is forwarded to a dispatcher for manualresolution, e.g., determination of missing information, such asaddressee(s) and/or choices, and/or determination regarding the currentscan's association with earlier scanned pages.

At block 1730, the form represented by the current scan is parsed inaccordance with the type of form previously identified and thecharacteristics thereof. Information typically sought, identified and/orextracted during form parsing includes one or more of addressee(s),choices, images spaces, such as handwritten material, drawings, photos,clippings, etc., and 2^(nd) or following pages. According to oneembodiment, addressee(s) and choices may be determined using variousimage processing techniques, such as XORing the original sector of theform with the marked version. In this manner, checked boxes, filled-inboxes and boxes marked in other ways may be interpreted as a selectionof the addressee or choice associated with the marked box.

Some information is optionally defaulted within the scan data structurebased upon the barcode value. For example, in the case of an eCardresulting from a coaching message, the communication service providermay know a priori the addressee(s) and need only determine one or morechoices and an image region containing a handwritten message to completecomposition of the missive.

In one embodiment, information extracted from a form filled in by theelder may be used to build a digital gift for one or more addressees.For example, a one-page form, such as eCard form 1600 of FIG. 16, may beused by an elder to select a type of Halloween eCard for delivery to oneor more members of the elder's caregroup. The form may include an areafor selecting one or more addressees (or the addressees may bedetermined based on the form identification barcode 1610), an area forthe elder to provide a hand-written note (e.g., handwriting sector1630), and a selection area to indicate choices made, such as acheck-off list for selection of a desired image to be used for theHalloween eCard (e.g., selection sector 1620). Continuing with thepresent Halloween eCard example of FIG. 16, upon receipt of the scannedimage of the eCard form, the form type is determined from the formidentification barcode 1610, the originator may be determined based uponthe form identification barcode 1610 or the unique ID associated withthe digital mailbox appliance, and the addressees (e.g., the two nephewsand an appropriate email address (or addresses) for delivery, such astheir mother's email account) may be determined based upon informationmarked by the elder in an address segment of the form or based upon theform identification barcode 1610, which may associated the form with aparticular coaching message concerning the nephews. Additionally, adetermination can be made regarding the image the elder has selected tosend (e.g., from a marking in a check box associated with the desiredimage 1621). Finally, an image of writing and/or any additional drawingsmay be extracted from the handwriting sector 1630 to form the inside ofthe eCard being sent.

According to one embodiment, instructions for composition of the eldermissive based upon the particular form employed are retrieved from thecentral service database. The instructions from the central servicedatabase may then be used to compose a completed missive from the parsedcomponents. This includes appending follow-on page images to the coredocument (for example an embedded handwritten note appended to abirthday card).

At decision block 1745, a determination is made regarding thecompleteness of the missive. If insufficient data is available toconstruct the missive (e.g., no marking in a selection section of theform), then composition cannot be completed, the processing state ismarked in the central service database, a notification is sent to thedispatcher and processing continues with block 1755. If sufficient datais available to construct the missive, then processing continues withblock 1750.

At block 1750, the missive is sent (e.g., emailed) to the appropriateaddressee(s) by the methods specified in their respective personalinformation stored in the central service database. Typically, thespecified method is defaulted to the primary email address.

FIG. 18 is a flow diagram illustrating a method of performing coachingand monitoring analysis according to one embodiment of the presentinvention. While making the interfaces to the communication serviceprovider for both the caregroup members and the target of the caregroupexceptionally easy is one mechanism to influence the quality, quantity,effect and timeliness of communications; a variety of monitoring andassessment techniques are also provided according to various embodimentsto allow the administrating caregiver(s) and other authorized familymembers to influence communications to and from the elder.

According to various embodiments, the communication service provider maybe provided limited access to communications exchanged between membersof caregroups and corresponding caregroup targets for the purpose offacilitating the monitoring of usage of various technologies andfeatures provided by the communication service platform and then takingor suggesting actions to administrating caregivers in response tovarious observed usage patterns. In one embodiment, such actionssuggested or taken by the communication service platform are designed toseek to enhance the effectiveness of the communication system platformin supporting elders, for example, by stimulating increasedcommunication with the elder if a drop in communication rate isdetected.

In one embodiment, the communication service provider may be providedlimited access to data that spans multiple caregroups. For example,while the communication service provider and/or affiliated researchersmay derive statistical baseline data that can be used to analyzebehavior of an elder within a single caregroup, it is anticipated thatdata collection and analysis may be performed across a type of communityof caregroups where the associated elders are demographically orpsychographically similar.

The coaching features may employ a supporting technology referred to asproject templates. An example of a project template is a user tool that(1) makes it easy for a family member to initiate a project, such asbuilding a family recipe collection, or creating a cryptogram puzzlewith text of interest to the elder, or providing a Health Tip of theWeek, while (2) allowing the communication service platform to recognizeand track that the activity is taking place. By monitoring the use ofsuch project templates, the communication service platform can determinewhich system features are being used and which are not, and suggest newprojects and/or activities, if appropriate, in response to a drop incommunication with the elder. Additionally, the communication serviceplatform may provide guidance and/or direction regarding potentiallyuseful features of the system that are not being used spontaneously bymembers. For example, coaching messages may be delivered to caregroupmembers regarding content types they have not yet used (e.g., eCards,crossword puzzles, family recipes, carousels for supplying commercialand/or family data streams, health advice, amusing news, entertainmenttopics, such as celebrity gossip and TV and/or movie reviews, specialinterest etc.). According to various embodiments of the presentinvention, each content type is supported by a corresponding projecttemplate that may act both as a tool to make it easier for caregroupmembers to use the associated feature, and as a marker, enabling thecommunication system platform to recognize and track the features beingutilized.

According to one embodiment, administrating caregiver(s), otherauthorized family members and personnel associated with thecommunication service provider (if desired and authorized by thecaregroup) may be provided with access to a communications dashboardthat presents communication history (under a variety of novel analyses)and a wide variety of coaching tools that can be used to influencecommunications to and from the elder. These coaching tools may becoupled with subtle (often indirect) coaching techniques to encouragethe creation of digital gifts and other communications to and/or fromthe elder.

At block 1810, various information is measured regarding thecommunications exchanged between members of a caregroup and the targetof the caregroup. In one embodiment, information measured and/or trackedincludes number of digital gifts exchanged, time, date, sources andtypes of digital gifts and the content employed (e.g., component imagesembedded in the digital gifts), the level of personalization of digitalgifts, and key words indicative of effectiveness of the communication.

At block 1820, various analyses are performed based upon the informationmeasured. For example, analysis may be performed to produce one or moreof an effectiveness rating, a rating regarding intellectual stimulus,and a rating regarding activity inducement. Digital gifts often includefamily annotated images. These annotations allow metrics to be generatedregarding the emotional content of the digital gifts. For example, adigital gift including an annotated photo that refers to the name ornickname of grandchildren and/or includes affective terms (e.g.,smiling, happy, . . . etc.) may have a higher affective value ratingthan a digital gift including a stock photo. Lexical Semantic Indexing(LSI) and Lexical Semantic Analysis (LSA) may also be used as onemeasure of the similarity between images. Other specific informationavailable for analysis includes names, nicknames, kinship, elder ratingsof information received (from, for example, best-of ratings that mayoccasionally be requested from the elder), family events from theschedule (birthdays, valentine's day, . . . etc.).

Simplistic analysis may involve a count of digital gifts delivered bymember, by type, by time. More complex analysis may involve ratingvarious parameters, such as affective-emotional value (A) ofcommunications, intellectual stimulus value (IS) of communications, andactivity induced value (AI) of communications, based on the content ofthe communications, e.g., digital gifts and associated images and text.

According to one embodiment, digital gifts may be scored based on thesum of items plus an individual weighting for various digital gifttypes. For example, digital gifts may have associated base rating valuetuplets (A, IS, AI) with enhanced points available for specific contentanalysis (e.g., use of a family photo of the grand-daughter over a stockphoto, a new stock image was selected as opposed to using the systemsupplied first guess, whether personalized text was added, . . . etc.).

Scoring a crossword puzzle might proceed as follows. If delivered as apersonalized digital gift from a member of the caregroup, base giftvalue of (5, 10, 5). If delivered in stock form (not personalized), basegift value of (1, 3, 2). Puzzles also might include associated ratingvalue tuplets (A, IS, AI) based on difficulty, complexity, number ofwords, length, subject matter, etc. Puzzles might have IS ratings of 1to 10 and AI ratings of 1 to 10. A particular puzzle might have a ratingvalue tuplet of (0, 5, 5). According to the present example, when thisparticular puzzle is delivered as a personalized digital gift the totalscore would be (5+0, 10+5, 5+5)=(5, 15, 10). In contrast, when thisparticular puzzle is delivered without personalization, the total scorewould be (1+0, 3+5, 2+5)=(1, 8, 7).

Scoring a photo essay might proceed as follows. Base gift value of (5,2, 0), plus an author bonus of 1 to 10 points (A) depending on age andkinship, plus a per item bonus of 1 to 10 point (A) for each imageincluded in the photo essay depending upon the subject matter depicted.

According to one embodiment, intellectual stimulus of content fromvarious information feeds and from the central service database of thecommunication service provider that are delivered to elders, such ascrossword puzzles, interest based items, . . . etc., may be rated by thecommunication service provider based on the content source or byexplicit ratings stored within the central service database by a contentmanagement team associated with the communication service provider.

At block 1830, responsive to a selection of a coaching tool from thedashboard of the communication service provider website interface by anappropriate caregroup member, the corresponding coaching editor isdisplayed. The dashboard may support a number of coaching and remindingtools and editors available both to the appropriate family member(s) andthe communication service provider (human-driven and/or automated).Various forms of indirect coaching and prompting have been found to havea significant impact on the quantity and quality of communications.According to various embodiments, authorized family members may usecoaching tools/editors to perform one or more of the following:

-   -   annotate a weekly summary of digital gifts (and in particular        their family photos) sent widely throughout the family,    -   launch reminders of upcoming family events (birthdays, father's        day, . . . etc.) with embedded digital gifts ready for immediate        sending or editing (to the elder or other family members),    -   follow up to doctor's appointments or physical therapy sessions        (could triangulate with message from doctor or therapist),    -   send projects of varying sizes to the elder (e.g., a        return-reply requested form, such as a photo journal (see FIG.        12), a life harvest album (see FIG. 13), or an eCard form for        sending a birthday card or holiday card to a specific family        member (see FIG. 15 and FIG. 16)). Furthermore, these items can        be directed through other family members to broaden the base of        communications.    -   welcome new members to the caregroup,    -   notify members of the availability of new digital gift editors        or new content enhancing existing digital gift editors,    -   create best-of selections,    -   remind members of digital gifts that they have not tried, or not        tried for a significant length of time (this function is        typically automated based upon parameters set by the dashboard        operator),    -   request additional personal information from members for the        directory and the family schedule (such as birthday        information),

Examples of various coaching editors are described below. At block 1840,the coaching editor composes the coaching message responsive to userinput. At block 1850, the coaching editor receives a list of one or moreaddressees to which the coaching message is to be distributed. At block1860, the coaching message is distributed to the addressees.

The dashboard may also enable the user to specify notifications and/orreminders to be sent to him/herself on specific conditions (e.g., lowlevels on specified content carousels, lack of personalizedcommunications to the elder, lack of intellectual stimulus items, . . .etc.).

Similar and/or additional dashboard capabilities may also be madeavailable to communication service provider operated services. Thus, thecommunication service provider may automate various coachingmethodologies for a newly formed caregroup until one or more familymembers take responsibility for various services (e.g., providing aweekly update of elder deliveries to the caregroup, notification of neweditors of content, event reminders, . . . etc.).

Simple coaching (automated and/or manual) is based on use or nonuse ofspecific features, or on overall usage levels. But, more sophisticatedcoaching may also encourage particular categories of use as describedfurther below. For example, by examining the assessed value ofcommunications between caregroup members and the target of the caregroupand/or usage of various project templates across a family, thecommunication service platform may detect that the family is makinglittle use of features that emphasize affective content (for example,family photos), or features that promote cognitive stimulation (forexample, puzzles or projects), and suggest features in these categories.Similarly, if a family is not using any features that direct health orlifestyle information to the elders, coaching messages may be used toencourage doing so.

According to an alternative embodiment, digital gifts can be gatheredinto a daily delivery or “Daily Edition”, rather like a familynewsletter. Typically, a cover photo and a table of contents is used asa cover page. The Digital Edition also plays a useful role inencouraging communication among family members: when family members knowwhat the elder is seeing in the Digital Edition, it stimulates them tocommunicate more with the elder, and with one another. That is, onefamily member's communication prompts communication by others. Accordingto one embodiment, the communication service supports this implicitcoaching effect by making Digital Edition contents available to familymembers on the Web via the family VPN website, for example.

FIG. 19 illustrates a user interface screen 1900 depicting a coachingmessage editor for a weekly summary according to one embodiment of thepresent invention. According to the present example, the administratingcaregiver(s) may periodically, e.g., weekly, provide an update orsummary to the caregroup regarding communications among the caregroupmembers and the user of the digital mailbox appliance corresponding tothe caregroup.

If the administrating caregiver(s) participate in more than onecaregroup, they initially select the caregroup via a user interfaceinput object, such as a caregroup dropdown list 1910. The administratingcaregiver may also select the caregroup members to which this coachingmessage is to be sent by using user interface input objects, such as the“Send To” radio buttons 1920 and/or corresponding dropdown Caregroupmember email list.

According to various embodiments, some types of coaching messagepre-filter (or at least suggest a filtering) of member addressees. Forexample: ex-officio members may be filtered from certain types ofcoaching messages as appropriate. A welcome coaching message suggestsinclusion of only caregroup members who have not been introduced to thecommunication service or website, or who have not responded to anearlier welcome coaching message. The weekly summary email newslettercoaching message may filter caregroup members who have opt-ed out. Acoaching message relating to encouraging the use of a particular digitalgift type would presumably filters any caregroup members who have triedthe particular digital gift type within a specified time period.Coaching messages requesting personal information may filter caregroupmembers who are current with regard to their personal data.

Returning to the present example, an “Editions Count” numeric displayfield 1930 may provide an indication of the number of daily deliveriesthat were sent to the digital mailbox appliance user during thecorresponding period being summarized. The administrating caregiver mayprovide text commentary in an “Initial Text” text input field 1940explaining the newsletter or pointing our items of particular interest.Finally, before distributing the newsletter, the administratingcaregiver may preview the newsletter by selecting the “PreviewNewsletter” button 1950. Responsive to selection of the “PreviewNewsletter” button 1950 a user interface screen may be presented to theadministrating caregiver to allow the newsletter to be viewed in theform in which it will be distributed according to currently selectedparameters, such as timeframe, recipients, etc.

FIG. 20 illustrates a review coaching message user interface screen 2000according to one embodiment of the present invention. In the presentexample, the administrating caregiver is provided an opportunity toreview the newsletter prior to distribution to the list of recipients.The text message entered within the “Initial Text” text input field 1940is displayed as introductory text 2020. A link 2015 is provided tofacilitate easy access to the caregroup's website and encouragecaregroup members to visit the website. The preview also includes a setof thumbnail image links 2030 to the various daily deliveries sent tothe digital mailbox appliance user during the period at issue.

FIG. 21 illustrates a member activity user interface screen 2100summarizing information regarding communications by members of aparticular caregroup according to one embodiment of the presentinvention. In the present example, if the administrating caregiverparticipates in more than one caregroup, he/she may select one of thecaregroups via a user interface input object, such as a caregroupdropdown list 2110.

Responsive to selection of the caregroup of interest, a member activityreport 2120 may be displayed. In the present example, the memberactivity report 2120 includes a name column 2121, a last login column2122, a number of articles column 2123, a last article column 2124, anumber of items column 2125, and a last item column 2126. More or fewercolumns may be provided depending upon predetermined or configurablesettings associated with the member activity report 2120. For example,columns may be included for the individual rating values describedabove, e.g., effectiveness rating, intellectual stimulus rating, andactivity inducement rating.

The member activity report 2120 may be used by administrating caregiversand/or customer service representatives of the communication serviceprovider to make decisions regarding the types of coaching messages theywould like to send and the targets of such coaching messages. In oneembodiment, the administrating caregiver may sort the various columns2121-2126 in ascending or descending order to assist processing of theinformation presented in the member activity report 2120. Theadministrating caregiver may also select an individual caregroup memberfrom the member activity report 2120 to obtain detailed informationconcerning the selected caregroup member's communications and activitieswithin the communication system. As described further below variousother charts, meters, tables, and reports may be provided to theadministrating caregiver(s) and/or customer service operators of thecommunication service provider. Such tools may be used to analyze thecommunications being exchanged among the caregroup members and thedigital mailbox appliance user corresponding to the caregroup.

After having used various communications analysis tools, theadministrating caregiver may select a coaching messages tab from his/herdashboard to choose from a collection of prompt editors. Theadministrating caregiver may create special coaching messages or editthe configurations of automated prompts (e.g. weekly summary, new gifts,. . . etc.).

Returning to the present example, the name column 2121 of the memberactivity report 2120 lists the members of the selected caregroup and thedigital mailbox appliance user associated with the selected caregroup.The last login column 2122 indicates the time and date of the lastcaregroup website login by the corresponding caregroup member. Thenumber of articles column 2123 indicates the number of articles thathave been contributed to the daily delivery by the correspondingcaregroup member allowing the administrating caregiver to evaluate therelative participation of the caregroup members. The last article column2124 provides information regarding the date and time of the lastarticle contributed to the daily delivery by the corresponding caregroupmember allowing the administrating caregiver to see how current theparticular caregroup members' participation in the daily delivery is.The number of items column 2125 provides information regarding thenumber of digital gifts delivered to the user of the digital mailboxappliance by the corresponding caregroup member. The last item column2126 provides information regarding the date and time of the lastdigital gift sent by the corresponding caregroup member.

FIG. 22 illustrates a drill down member activity user interface screen2200 listing communications by a specific member of a caregroupaccording to one embodiment of the present invention. In the presentexample, the drill down member activity user interface screen 2200 ispresented responsive to selection of a particular caregroup member bythe administrating caregiver from the member activity report 2120.According to one embodiment the drill down member activity userinterface screen 2200 may display a drill down member activity report2210 including a title column 2211, a last updated column 2212 and aview column 2213. As above, more or fewer columns may be provideddepending upon predetermined or configurable settings associated withthe drill down member activity report 2220. For example, columns may beincluded for one or more of individual effectiveness, intellectualstimulus and activity inducement rating values. Additionally, a columnmay be included relating to the various digital gifts sent by thecaregroup member. Alternatively, a separate drill down member activityreport relating to digital gifts may be included among the communicationanalysis tools provided to administrating caregivers.

In the present example, the title column 2211 of the drill down memberactivity report 2210 lists the titles of the various articlescontributed by the selected caregroup member. The last updated column2212 indicates the date and time the corresponding article was lastupdated. Finally, the view column 2213 provides a link to thecorresponding article to allow the administrating caregiver to quicklyreview contributions by the selected caregroup member.

FIG. 23 illustrates an exemplary chart or dashboard monitor 2300 foreffects of communications delivered to a particular elder that may bedisplayed within a user interface screen according to one embodiment ofthe present invention. According to the example illustrated, the effectschart 2300 visually depicts cumulative assessed rating values in theform of a bar chart for three exemplary categories of effects, i.e.,activity induced 2310, intellectual stimulus 2320, and affectiveness2330, by month. Various other charting formats may be used, e.g.,histogram, pie chart, etc., and differing aggregation timeframes may beused, e.g., day, week, year, etc. Charting and/or timeframe parametersmay be predefined and user selectable or configurable by theadministrating caregiver.

FIG. 24 illustrates an exemplary chart or dashboard monitor 2400 ofcommunications delivered to a particular elder by caregroup member thatmay be displayed within a user interface screen according to oneembodiment of the present invention. According to the exampleillustrated, the communications chart 2300 visually depicts thecumulative number of communications delivered to the particular elder inthe form of a bar chart by caregroup member 2410-2490 and by month.Various other charting formats may be used, e.g., histogram, pie chart,etc., and differing aggregation timeframes may be used, e.g., day, week,year, etc. Charting and/or timeframe parameters may be predefined anduser selectable or configurable by the administrating caregiver.

FIG. 25 illustrates an exemplary chart or dashboard monitor 2500 ofdigital gifts by category delivered to a particular elder that may bedisplayed within a user interface screen according to one embodiment ofthe present invention. According to the example illustrated, the giftcategories chart 2500 visually depicts the cumulative number of digitalgifts delivered to the particular elder in the form of a bar chart bydigital gift category 2510-2560 and by month. Various other chartingformats may be used, e.g., histogram, pie chart, etc., and differingaggregation timeframes may be used, e.g., day, week, year, etc. Chartingand/or timeframe parameters may be predefined and user selectable orconfigurable by the administrating caregiver.

FIG. 26 is a flow diagram illustrating a method of performing goodguessing according to one embodiment of the present invention. Accordingto various embodiments of the present invention, the communicationsystem platform, via caregroup websites, for example, may providedistinct editors for each digital gift type. In one embodiment, in orderto facilitate the creation of digital gifts and encourage caregroupmembers to participate in digital gift giving to the digital mailboxappliance user associated with the caregroup, techniques are employed toestablish intelligent defaults for content fields of digital gifts.These techniques are referred to herein as “good guessing.”

Examples of content fields include an eCard image, the greeting titletext, and the ‘interior’ sentiment and signature text. According to oneembodiment, good guessing is predicated on data collected by thecommunication service provider about the family or caregroup and/orcontext of the communication or the type of communication. For example,various information that may be used during good guessing processingincludes one or more of the following: the caregroup member's biographicinformation; information regarding communications history between one ormore members of the caregroup and the focus of the caregroup, such asthe caregroup's specific communications activities, the specificcommunication history between the caregroup member and the user of thedigital mailbox appliance; ascertained preferences of the target of thecaregroup, the content created by the caregroup and/or the particularcaregroup member, the type of the digital gift, and/or any survey datacollected regarding their “out of band communications” (e.g., phonecalls, emails between caregroup members that are not though thecommunication service provider, physical visits, etc.). Additionally,images and text included in digital gifts have associated keywords thatmay be used in categorization schemes for specific editors, such as abirthday card editor. Content supplied by the communication serviceprovider and used by caregroup members may also have value in a searchfor a good guess.

According to the present example, each content-containing component of adigital gift has an associated query that is used to select from contentitems. Content items have fields for the image URL, subtitle text,commenting text, source (e.g., caregroup member, communication serviceprovider staff), date, key-words (used for categories, etc.), seen(date) over which the queries are run. At block 2610, the data collectedand maintained in the communication service provider's central servicedata base is queried to retrieve potential datum for use in filling thecurrent content containing digital gift field. For example, the querymay be against the caregroup member's information and communicationshistory with the user of the digital mailbox appliance and/or withothers. Various other examples of specific data that may be collectedfor use in good guessing is described further below.

At block 2620, a sorting methodology is applied to the retrieved datumto select a specific retrieved datum for inclusion in the currentcontent-containing component of the digital gift. Various sortingtechniques may be employed, such as goodness of fit to various numericalassessments, least recently used, randomization, etc.

At decision block 2630, a determination is made whether morecontent-containing components remain that have not been assigned a goodguessing default. If so, then processing continues with block 2610;otherwise, processing proceeds to block 2640.

At block 2640, the selected digital gift is displayed within thecorresponding digital gift editor and each content-containing field ofthe digital gift is filled-in with the previously guessed content.

As indicated above, good guessing relies upon data collected andmaintained by the communications service provider. Examples of specificdata collected includes information about caregroup members (such asthat entered into a member personal information user interface screen2700 like that depicted in FIG. 27), about the elder/family schedule(such as that entered into an elder's schedule user interface screen2800 like that depicted in FIG. 28), about specific communications (suchas a photo essay 2900 like that depicted in FIG. 29), from occasionalsurveys that might be conducted. Data from such surveys might includerecollection of phone calls, recollection of member-member emailingoutside of the communication system platform and recent visits to theelder, including, duration, topics discussed, . . . etc.

FIG. 27 illustrates a member personal information user interface screen2700 according to one embodiment of the present invention. Caregroupmembers or administrating caregivers may enter various information, suchas name, address, phone numbers, email addresses (including cameraphoneaddresses), birthdate (the year is recorded but may not be posted), IDphoto(s), opt-in coaching permissions, editing privileges, . . . etc.),nick names, . . . etc., via a pop-up editor (or pop-ups) as shown 2710and as described further below.

FIG. 28 illustrates an elder's schedule user interface screen 2800according to one embodiment of the present invention. In one embodiment,information regarding the elder's and/or the family's schedule may beprovided via user interface screen 2800. Examples of information thatmight be entered and maintained on behalf of a family caregroup includesfamily recognized holidays, birthdays (from the core member data),events (e.g., a Thanksgiving reunion), doctor's appointments, . . . etc.Information here can be used to drive various coaching opportunities toboth the elder and caregroup members.

FIG. 29 illustrates an example of a user interface screen 2900 depictinga photo essay type digital gift according to one embodiment of thepresent invention. According to one embodiment, the communicationservice provider collects and maintains information about specificcommunications in order to facilitate charting and reporting to theadministrating caregiver(s) and to support good guessing.

Such information collection is simplified by the fact that all digitalgifts delivered are generated from a database record created by thecaregroup member's interactions with a specific digital gift editor, orparsing of a traditional email. The more precise the records, the morehelpful the coaching and good guessing will be.

Information that may be collected regarding a particular digital giftincludes the type of message (e.g., digital gift), header information(such as source, recipient(s), date, title, etc.), gift type (e.g.,photo essay), creation date, delivery date, images used (both familycontent and content supplied by the communication service provider),various categories of text (such as that associated with specificimages), etc. Images typically have subtitle and body text associatedwith them. This text often contains information that can be correlatedand used in good guessing.

FIG. 30 illustrates a user interface screen 3000 depicting an initial(blank) photo essay 3010 (or photo journal) type of digital gift withembedded edit stimulus markers 3011-3115 according to one embodiment ofthe present invention. Using the popup editor mechanism, each fieldpresents (one or more) presentation components. Thus, responsive toselection of an editable field, such as 3014, by the end user, an imageeditor 3016 might present a light table with image content supplied bythe communication service provider, or family images or an imageuploading tool.

FIG. 31 illustrates a user interface screen depicting a personalizableready made eCard type of digital gift resulting from good guessingaccording to one embodiment of the present invention. Within the basiceCard editor 3100 the system has guessed that a Halloween card is whatis likely to be appropriate and in particular a colorful image ofHalloween gourds has been guessed. It is highlighted yellow because theuser has passed the mouse over the image. Selecting the image brings upa light table of likely alternative images 3110. Selecting and imagefrom the light table of likely alternative images 3110 would replace thecurrent eCard image.

FIG. 32 illustrates various user interface screen shots, selection froma collection of digital gifts and good guessing defaults according toone embodiment of the present invention. According to the presentexample, a caregiver has logged into a caregroup VPN and is taken to ahome page 3200 for the caregroup website, e.g., the “What's new?” page.Here the caregroup member may be presented with cover photo thumbnails3211 from the last week's daily deliveries that have already beendelivered to the elder. Selecting one of the thumbnails 3211 retrievesand presents an electronic rendering of the corresponding dailydelivery. Selecting a digital gifts button 3210 (2nd from the left onthe navigation bar) the caregroup member is presented with a list ofpossible digital gifts 3220 to send the elder (or another member of thecaregroup).

Upon selecting a digital gift type, a custom editor for the selecteddigital gift type is opened. For example, if the caregroup memberindicates he/she would like to send a thank you note by selecting the“Thank you note” hyper link 3221, then a thank you note editor 3230 ispresented with a thank you note 3240 containing good guessing defaultsfor the title 3241, picture 3242, and sentiment 3243 as describedearlier. The good guessing defaults may be changed by the caregroupmember by selecting the particular content containing element andreplacing it with personalized content. Alternatively, if the caregroupmember indicates he/she would like to send a photo collage by selectingthe “Photo collage” hypertext link 3222, then a photo collage editor3250 is presented with recently uploaded photos from the caregroupmember's camera phone. Again, the caregroup member may edit the digitalgift before sending it by adding, deleting and/or replacing photos, forexample.

FIG. 33 is a flow diagram illustrating a method of interacting withpop-up forms according to one embodiment of the present invention. Inthe example depicted, pop-up form processing begins at block 3310responsive to selection of a field or group of fields by a caregroupmember from within an editor, such as a digital gift editor. At block3310, an indication of the selected field or group of fields isreceived. At block 3320, a pop-up form corresponding to the selectedfield or group of fields is presented to the caregroup member. After thecaregroup member has made the appropriate choices and/or provided therequested information and submitted the pop-up form, at block 3330, anindication is received by the originating editor that the pop-up formhas been completed. Then, at block 3340, the originating editor isre-rendered based upon the information submitted via the pop-up editorthereby giving the caregroup member real-time feedback regarding theeffects his/her decisions/selections have on a digital gift beingcreated, for example.

FIG. 34 illustrates customization and re-rendering of a pop-up in thecontext of a note editor according to one embodiment of the presentinvention. Continuing with the example discussed with reference to FIG.32, upon receiving an indication by a caregroup member that he/she wouldlike to create a thank you note, the “thank you note” editor 3230 ispresented with “good guesses” regarding appropriate content for fields,such as a likely image for picture field 3232, within the thank you note3240. Note the “Send it!” button 3270 in the lower right hand corner ofthe thank you note editor 3230. The thank you note 3240 is ready to goif the caregroup member is satisfied with the defaults selected by thegood guessing process. If the caregroup member likes what they see theycan send the thank you note 3240 immediately.

As described earlier, the thank you note editor 3230 employs goodguessing to supply the likely image, text for the title, and even adraft sentiment (derived from the message type, communications historiesof both the caregiver and the elder, and numbers of other parameters).If the caregroup member would like to revise one of the editablecomponents, such as the image for picture field 3232, they arehighlighted in some manner to indicate their editability, for example,by being bordered with a dashed red outline. In the present example, thecaregroup member has selected the picture field 3232 to chose adifferent image. Selecting the picture field 3232 brings up a pop-upwindow 3400 providing a table of options 3410. Choosing a personalpicture of the grand daughter 3415 from the table of options 3410 causesthe thank you note editor 3230 to re-render the revised thank you note3260 (which now includes the selected image 3415 in the picture field3232) to send or modify further.

FIG. 35 illustrates examples of various pop-ups 3510-3560 according toone embodiment of the present invention. Pop-up 3510 is an example of apop-up window that may be used to change the title and text associatedwith a picture in the caregroup member's shoebox. Pop-up 3520 is anexample of a pop-up window that may be used to change the delivery dateof an article submitted by a caregroup member for publication in a dailydelivery. Pop-up 3530 is an example of a pop-up window that may be usedto allow a caregroup member to select a picture from the caregroupmember's shoebox. Pop-up 3540 is an example of a pop-up window that maybe used to provide an administrative caregiver with mutually exclusiveoptions from which to select for configuring various parameters withinthe caregroup VPN. Pop-up 3550 is an example of a pop-up window that maybe used to edit groups of related fields, such as biographic informationand contact information. Pop-up 3560 is an example of a pop-up windowthat may be used to change text associated with a picture in the contextof a photo essay or photo journal digital gift, for example.

FIG. 36 illustrates examples of various digital gifts according to oneembodiment of the present invention in the form of a collage including apersonalized weekly calendar digital gift 3610, an astronomy picture ofthe day digital gift 3615, a daily delivery publication digital gift3620, an orchid of the day digital gift 3625, an annotated cartoondigital gift 3630, a personalized (eCard) birthday card digital gift3635, a crossword puzzle digital gift 3640, a daily jokes digital gift3645, a kid art digital gift 3650, a photo essay digital gift 3655, aphoto collage digital gift 3660, a family weather digital gift 3665, aweb clipping digital gift 3670.

As should be appreciated, various art and projects from the elder'sgrand children or other relatives serve as particularly valuedcontributions to the daily delivery. In pilot studies, both the elderand all the adult caregroup members remarked in surveys on theirparticular pleasure in these occasional contributions.

A favorite family photo with the next week's schedule of events,maintained as part of the Discussion site, for example, may serve as theraw material. Any family member can use the calendar Digital Gift toprovide a calendar that the elder can print out and post. The weeklycalendar is of particular interest because it may serve as a mechanismfor family members to coach the elder for upcoming events such asdoctor's appointments, family visits, the monthly hair appointment,physical therapy, . . . etc.

FIG. 38 illustrates a specific example of a Halloween card 3800 sentduring a field test implemented by the assignee of the presentinvention. In this specific example, the family “knew he was back to hisold self” when the elder decorated the Halloween card 3800 he wassending with his old “mustachioed Portuguese guy” logo humorouslyadapted as a pumpkin face 3810.

FIG. 39 illustrates examples of various samples of coaching ortherapeutic digital gifts according to one embodiment of the presentinvention in the form of a collage. Family members may find a myriad ofways to exploit digital mailbox communications to encourage, to coach,to stimulate, to facilitate, to remind, to test, to strengthen thespirit of their loved ones. According to the present example, thecoaching or therapeutic digital gifts include, a typical cheerful getwell card 3900, a weekly schedule 3910: reminders of appointments,therapy, . . . coupled with a favorite family picture encouragingputting the schedule on the refrigerator door, Information on an AARPsafe driver program—a web clipping that a niece gathered upon request3920, a crossword puzzle sent to provide intellectual stimulus, or tohelp pass the time while convalescing 3930, Just a quick sharing-lifepick-me-up of a CameraPhone collage 3950, an actual clinical screeningtest for depression (clipped from the web) 3940. There are similar testsfor Addictive behaviors, anxiety, chronic fatigue, abuse, alcoholassessment, nutrition assessments, geriatric depression, stress, . . .etc.

EXAMPLES

As a result of the flexibility provided by the various embodiments ofthe communication system and methods described herein, it should beappreciated that it is not feasible to comprehensively describe allpossible usage scenarios and interactions between or among theparticipants. Consequently, while various treatment and diagnosisexamples are provided below in order to facilitate understanding of theflexible nature of the described communication system, the examplesshould not be considered to be all-inclusive or static. Furthermore, theexamples should not be considered mutually exclusive.

Example #1 Coaching Physical Therapy

The assignee of the present invention observed during a field trial thatone of Elder A's daughters was sending him bawdy barroom style jokes.This had not been a previous characteristic of their interactions so itwas investigated. It turns out that she was sending the jokes for ElderA to use with his fellow ‘senior guys’ at Physical Therapy sessions.Elder A had become ‘mister joke man.’ Interviewing the daughter, itturns out she was doing this to remotely encourage (and monitor) ElderA's attendance at physical therapy. The jokes not only gave Elder A akind of social currency and status at physical therapy but also gave hisdaughter an excuse to find out how the ‘boys’ liked it thereby checkingin on Elder A's attendance at an activity that heretofore he hadeschewed. The daughter was both enabling and coaching Elder A'sattendance in a socially acceptable manner without appearing to nag. Theprecursor communication system made the finding and delivery of thejokes a minimal task for the daughter. In this case, the monitoring wastypically done during weekly or bi-weekly phone calls in which the jokeswere a regular source of conversation.

Example #2 Alertment

FIG. 37 is a graph illustrating a sample plot of an elder's responserate over time. Within one embodiment of the closed communicationsystem, family members are provided with the ability to observe both thefrequency of elder responses to various types of inquires as well as thequality of the responses (both the handwriting as well as the substanceof the missive—humor, wit, . . . etc.). Because the missives arearchived, they are easy to count over time as well as permittingspecific examination. So, observations regarding increases in themicrographic nature of the elder's handwriting might be indicative ofonset or worsening of Parkinson's disease. Decreases in the number ofresponses as shown in the response rate graph 3800 or a “flattening” ofthe content might warn family members of the approach of a depressivestate or cycle. Consequently, a drop off in responses (quantity andquality) with respect to one individual or in the aggregate may indicatethe onset or worsening of a particular physical or mental condition,disorder, disability or illness, injury, or chronic condition of theelder.

Example #3 Engendering a Purpose

Imagine a mother and daughters having a joint project to collect,present, and publish to the family mom's recipes. Various embodiments ofthe communication system platform described herein support and amplifysuch an effort even though it might involve multiple members of acaregroup spread across the continent. Imagine the daughters doing testpreparations of each of the recipes with their children and takingpictures of the activity as well as the results. These materials canthen be gathered into a publication (online or in book form) to beshared thoughout the family. This kind of activity not only provides ashared activity between a mother and her distant daughters but itactually can define a purpose for the elder. These kinds of purposefulactivities are known to extend the health and well-being ofparticipating elders.

Example #4 Putting Granny in-the-flow of Complex Family Life

In days gone by multi-generation living meant that as Granny aged shesat on a rocker by the hearth. From here she watched the kids running inand out, gave occasional advice, and told stories. GrannySnap seeks toreintroduce a significant part of that activity. In one embodiment,GrannySnap is a CameraPhone application that caregroup members canconfigure online and download from the family's website. In turns theCameraPhone into a direct pipeline from camera to a digital giftscheduled for the next delivery to grandma. In alternative embodiments,GrannySnap functionality may be configured on the CameraPhone too, plusit may be loaded from places other than the family's website. In apreferred embodiment, GrannySnap allows “one button” routing of contentfrom a CameraPhone to a predefined online area.

Say the kids are going to the zoo (in St. Louis, Granny is in SanDiego). Turning on GrannySnap, dad takes pictures of the kids watchingthe elephant, mocking the apes, and petting the llama. The pictures areautomatically sent to a collage for 8AM delivery to Granny. Thisprovokes a response from Granny commenting on her experiences with herfavorite horse when she was growing up. This provokes a phone call fromthe granddaughter, Maria, because she is writing a report on ruralliving for her social studies class. These kinds of interactions giveGranny her place across the generations, give her specific activities,and stimulate her memory and social interaction skills. These areexactly they types of social and productive activities that Thomas Glassand the MacArthur Foundation have show to improve the quality and extendthe life of the elderly. This example not only shows putting the elderinto the flow of the family, it shows how digital gifts provoke bothreturn gifts but also engender positive activity on the part of theelder.

Example #5 Reawakening Thoughts

Fifteen years ago, one of the elders involved in a field testadministered by the assignee of the present invention was an activeorchid fancier. He owned a greenhouse, bought, sold, collected andtraded specimens, and actively attended orchid shows. This interest wasmoribund. An orchid of the day digital gift stimulated this dormantinterest. Orchids are once again a subject of interest for the elder,and a positive topic of communication between the elder and familymembers. The elder explains to family members (who can share the dailycontent over the web) his personal knowledge of particularly interestingspecimens and reminisces of the days when he collected specimens inCosta Rica.

Example #6 Intellectual Stimulus I

Verghese, et al. (2003). Asserts “ . . . elderly persons who didcrossword puzzles four days a week had a risk of dementia that was 47percent lower than among subjects who did puzzles once a week.”Different elders have different preferences: for example crosswords,jumbles, chess, brain teasers, . . . etc. Caregroups are encouraged topick and choose intellectual stimulus that the elder is interested in.Various embodiments of the communication service described herein mayautomate, monitor, and notify interested members in the stimuliprovided. The communication service may also provide answer tools andmonitor elder performance. The sociology of what degree of monitoringand notification is desirable varies from caregroup to caregroupdepending on family sociology, elder preferences and the specificcircumstances of the elder. The communication system may leave theseissues as configurable parameters by the caregroup.

Doug's father, Jack (age 90), used to be a crossword puzzle fiend, buthas stopped doing puzzles in the last few years. Jack and Doug havealways enjoyed father-son friendly competitions: golf, fishing, etc. butdue to Jack's age and Doug now living several hours away, these outingshave stopped. Using the a communication service in accordance with anembodiment of the present invention, Doug arranges to send Jack acrossword puzzle 3 times per week. It's just a digital gift that he setsfor automatic delivery Monday, Wednesday, and Saturday. Saturday is“challenge day” since Doug just doesn't have the time to do thechallenge during the work week. Jack and Doug compare answers by phoneon Saturday afternoon. Jack tells his physician that he “feels greatgetting his brained exercised, and loves having a weekly challenge withhis son, now that they can't play golf or fish anymore.”

Example #7 Intellectual Stimulus II

A variety of games, such as family turn taking games, can be integratedinto the communication service platform. For example, Scrabble can beplayed with 0 to 3 other family members. Note that the communicationservice platform may automate one or more players, thus filling in for afamily member who misses a day. Some will prefer to play a day-a-movechess game with a favorite grand-niece. These activities provide severalpurposes. They provide: 1) significant intellectual stimulus, 2) dailyconnection with family members, 3) a tool for the other gamers tomonitor the elder's behaviors, 4) an anticipated activity for the elderto fill an otherwise lonely day.

Example #8 Affective Communications I (Kid Art)

One of the strongest effects in sustaining or recovering well-being isinterest and love being expressed by the youngest members of an elder'ssocial network. In a large percentage of Alzheimer's cases the primarycaregiver is an aging spouse. The incidence of high stress anddepression in such cases is high. Attendant with the ever acceleratingresponsibilities to the resident caregiver is a sense of isolation and afeeling of caring the burden alone. Various embodiments of thecommunication system platform described herein permit family membersfrom across the country to not only send items to the ailing elder butalso the burdened spouse. Everyday family members are checking in,buoying the spirits with news of grandchildren, just showing that theyare thinking of the caregiver. Family members may also monitor thespirit of the elder on an almost everyday basis. All of the observationsmade about being able to have earlier recognition of depressivebehaviors holds for the caregiver as well as the Alzheimer's patient.

Example #9 Coaching II

There are several barriers to increasing the amount and effectiveness ofcommunications with the elderly.

Lake of Awareness: With our busy lives even our dearest family membersdrop off our day-to-day radar. Various embodiments of the presentinvention addresses that in several ways:

-   -   Receipt of weekly updates regarding various digital gifts to and        from the elder. Seeing the photos or greeting cards or other        missives going to grandma reminds each of the members in the        caregroup of their impulse to tell her they care.    -   Receipt of simple direct hand-written messages from Grandma        directly to the members of her caregroup delivered to their        electronic world (e.g., email or cell phone).    -   Automated and/or member-to-member coaching messages and/or self        notifications providing regular reminders of easy, fun and novel        digital gifts to send.

Lack of Time: None of us has a lot of time in our busy lives.Embodiments of the present invention, respects the caregroup members'time by:

-   -   Providing a large number of specialized editors designed to        suggest and speedily compose a wide variety of evocative and        stimulating digital gifts that can be created and sent in as        little as 10 seconds.

Example #10 Diagnosis I

In June, Elder A is able to complete a reasonably complex crosswordpuzzle and is proud of the accomplishment. In September, Elder A isunable to complete a similar level of crossword puzzle and expressesfrustration to caregiver who sent puzzle. The communication system flagsthis and also has monitored other signs of decline (use of the digitalmailbox appliance), level of communications, handwriting, etc. Tosupport this use, the family caregiver could use the communicationsystem to administer periodic checks/tests to monitor the status of theelder. The communication system prompts the administrator to check tosee if there has been any change in treatment, such as new medications,with any of the primary caregiver, the elder, or the ex officiohealthcare professional.

Example #11 Diagnosis II

Based on significant experience with widely disseminated supportedcommunications networks, it is determined that, once a network has beenestablished, a level of elder activity sending at least 5 messages aweek and completing one puzzle or game per week indicates a healthystatus for a certain user demographic (e.g., female, widowed, age75-78). When variations from this level of usage occur, a caregiver isnotified. Patterns of communication are determined, so that it ispossible to have a better prognosis of the progression of a condition,such as Alzheimer's disease. For instance, if the number of messages,length of message or number of network members contacted decline over aperiod of time, it may be possible, based on studying large numbers ofelders, to predict when certain stages of disease may be reached. Thismay be useful to provide additional time to caregivers to determineadditional health care requirements (for instance, arrange for long termcare facility, move elder to a different place). Another potentialmeasure might be the rate of elder response to explicit coached replies,such as return-reply requested forms, eCard order forms, . . . etc.

Example #12 Diagnosis III

Various embodiments of the communication system monitor usage by primarycaregiver(s) to see if data or communication pattern changes couldsignal stress, depression or decline for this person. As an example,over time the system may establish that as communication by an elderdeclines, communication from a resident relative caregiver increases. Inthe event of Elder Y, as communication decreases, the communication fromElder Y's spouse, X, decreases at an even faster rate. The system couldnotify other caregivers, which might suggest a visit by another familymember, or that the spouse see their physician or generate health tipcoaching for the caregiver.

Example #13 Recovery from an Injury

Gertrude, age 84, breaks her hip in a fall in her home. Oven the nextmonths she is taken to the emergency room, has hip replacement surgery,goes from the hospital to a convalescence facility for several weeks andfor a final recovery two months with her daughter whole lives 5 milesfrom her home. All during this time from the hospital until she is backat home her digital mailbox is moved along with her: anywhere she has aphone line she remains connected. Better still her mailbox only requirespaper and pencil. Her support group uses it not only to send hermessages of concern and pleasant missives but also:

-   -   Digital gifts keeping her up to date on the Halloween season        with the kids she missed and the Thanksgiving with her son        John's family in North Carolina she had to forgo,    -   Sally, her daughter, notified all the family (including the        cousins in Newark) (“It's so nice that they all either called or        send a get well card”.),    -   Puzzles and entertainment to keep her occupied and her mind        alert (“that TV can be so deadening if you look at it all day”),    -   Information from web clippings on typical recovery processes for        her age group,    -   Resumed the running scrabble game she was playing on a daily        basis with the kids in Omaha,    -   Continued gathering of her comments on the compilation of family        recipes that her daughter Mary has been conducting with her over        the previous 6 months,    -   Reconnected with her niece in Wisconsin (“isn't it nice how even        a disaster can bring us all back together again”),    -   Coordinating her various moves (e.g. to the convalescence home)        with her daughter,    -   Getting encouragement from several members in her support group        on the 6 day a week physical therapy sessions (“including those        weird Ballard Street cartoons from Jenny—what is that about        anyway?”),    -   Arranging for regular delivery of the prescription medications        that her doctors want her to use during recovery (Sally sent her        that data showing her the benefits of this new pain medication        and assuring her that it has no addictive effects. “Who trusts        doctors anyway?”),    -   Letting the room therapist in the hospital keep the family up to        date on Gertrude's early progress,

This example extends to virtually any long term care, recovery orconvalescence—cancer, heart operation, back surgery, diabetes, . . .etc. It also shows the richness of purpose and effect that the manymembers of Gertrude's social support network can have, each helping justa little to accumulate to a great effect on Gertrude. Speeding herrecovery, keeping her on track with her therapy regimens, keeping herspirits up in a situation that threatens isolation, loneliness anddepression, helping with life's minor problems made impossible by beingimmobile, monitoring her progress without being pests.

Example #14 Injury (Memory) and Physical Therapy Compliance

John, age 36, is recovering from brain surgery which occurred after hewas injured when a rock came through his windshield. He has haddifficulty recalling events prior to the accident and has twice weeklyphysical therapy sessions as well as daily exercises he is supposed todo. By using the a communication system in accordance with an embodimentof the present invention, John's family support network is able to sendhim pictures of past events, along with descriptions of the event. Forexample, his sister Beth sent him pictures from a camping trip they hadtaken several years earlier and this triggered memories of fly-fishingfor John. In addition, John's digital mailbox appliance prints out adaily schedule, including physical therapy appointments and reminders toperform his exercises. In time, John recovered most of his memories andcompletes his physical therapy. John's physician felt that there hadbeen noticeable improvement in John after the communication system wasput in use, and that the communication system had assisted John'srecovery in several aspects: a) assisting memory recall; b) noticeableimprovement in physical therapy compliance and c) general feeling ofwell-being due to the feelings of support and affection he received fromhis family.

Example #15 Reducing the Risk of Substance Abuse

Rex, age 70, is a caregiver for Ethel, who is suffering from Alzheimer'sdisease. Their closest family members live several hundred miles away.Rex has a history of alcohol abuse, although he has been sober for 2years, and the family is concerned that with the additional stresses ofcaring for Ethel, Rex may start drinking again. By using a communicationsystem in accordance with an embodiment of the present invention tocommunicate with Rex and Ethel, the family is able to reduce caregivingstress and associated likelihood of depression for Rex by supportingEthel and reducing Rex's sense of isolation. In addition, by targetingspecific coaching and support messages for Rex, such as encouragement toattend church, exercise and play cards with some friends who don'tdrink, the likelihood or Rex abusing alcohol is reduced. Finally, thefamily is able to monitor Rex's behavior and can intervene if theydetect he has started drinking again.

Example #16 Drug Therapy Compliance

Jane is a widow, age 79, who suffered from diabetes, high cholesteroland early stage Alzheimer's disease. Jane, like many elderly patients,was taking 4 different prescription drugs, which had different pills,different doses (number of pills) and different dosing schedules. AsJane aged, she found it increasingly difficult to properly comply withher various drug regimens and her physician was concerned that thiswould compromise her health and ability to live independently. Using acommunication system in accordance with an embodiment of the presentinvention, Jane's physician and daughter customized a Digital Gift thatprovided Jane with a simple daily schedule and checklist for herprescriptions, which she used to check off and send back to the daughterand the physician's office each day. The problem was resolved for almost18 months and Jane was able to continue to live independently until shewas involved in a car accident, at which time she was placed in aresident care facility.

Example #17 System Generated Healthcare Provider Alert

Using the drug therapy compliance example above, during the 18 monthperiod of system use, during month 7, the physician prescribed a drug tohelp Jane sleep better. In the following week, Jane's communicationswith family members dropped significantly, and she failed to return 1 ofher daily prescription checklists. The system alerted the administratingcaregiver (daughter) and physician, who had earlier set up the system toalert them to changes in communication volume and for missed dailyreports. The daughter phoned Jane, who complained that she was feeling“tired and drowsy” and the physician adjusted the dose to resolve theproblem. Jane's system usage then returned to prior levels.

Example #18 Reduced Stress, Depression and Risk of Disease in Elder andPrimary Caregiver

A controlled study comparing 30 families with elders suffering fromAlzheimer's disease who used a prototype communication system to 30families with elders suffering from Alzheimer's disease who did not usesuch a system is being conducted. Afier the first year of this five-yearstudy, researchers have concluded:

-   -   i) that the amount of family communication with the elder has        increased by 35%;    -   ii) that in the communication system using families, the elder        is twice as likely to receive a daily communication from a        family member than the non-user elders;    -   iii) that elders in the communication system group reported a        higher level of well being, lower levels of depression and        stress, and fewer new health problems than the control group;    -   iv) that compliance with drug and physical therapy regimens was        significantly higher in the communication system using group of        elders;    -   v) that primary caregivers in the communication system using        group reported significantly lower levels of stress, depression        and new health problems than the control group.    -   vi) that participating family members of the communication        system using group reported a higher level of well being and        involvement and lower levels of stress and depression over elder        care than family members in the control group.

While embodiments of the invention have been illustrated and described,it will be clear that the invention is not limited to these embodimentsonly. Numerous modifications, changes, variations, substitutions, andequivalents will be apparent to those skilled in the art, withoutdeparting from the spirit and scope of the invention, as described inthe claims.

1. A communications network providing a closed communication service tofacilitate and encourage one or more of affective communication,activity stimulating communication and intellectually stimulatingcommunication among members of a caregroup and a subject that is atarget of the caregroup as a method of treatment for one or more of (i)a physical or mental condition, disorder, disability or illness, (ii) aninjury, and (iii) a chronic condition of the subject.
 2. Thecommunications network of claim 1, wherein the physical or mentalcondition, disorder, disability or illness is depression.
 3. Thecommunications network of claim 1, wherein the physical or mentalcondition, disorder, disability or illness is due to stress.
 4. Thecommunications network of claim 1, wherein the physical or mentalcondition, disorder, disability or illness is stress.
 5. Thecommunications network of claim 1, wherein the physical or mentalcondition, disorder, disability or illness is brain damage.
 6. Thecommunications network of claim 1, wherein the physical or mentalcondition, disorder, disability or illness is substance addiction. 7.The communications network of claim 1, wherein the physical or mentalcondition, disorder, disability or illness is substance abuse oraddiction.
 8. The communications network of claim 1, wherein the mentalor physical condition, disorder, disability, illness or chroniccondition is Alzheimer's disease.
 9. The communications network of claim1, wherein the mental or physical condition, disorder, disability,illness or chronic condition is a geriatric cognitive disorder.
 10. Thecommunications network of claim 1, wherein the mental or physicalcondition, disorder, disability, illness or chronic condition is heartdisease
 11. The communications network of claim 1, wherein the mental orphysical condition, disorder, disability, illness is cancer.
 12. Acommunications network providing a closed communication service tofacilitate and encourage one or more of affective communication,activity stimulating communication and intellectually stimulatingcommunication among members of a caregroup and a target of the caregroupas a method of improving well-being or reducing stress of a primary,residential caregiver of the target.
 13. The communications network ofclaim 12, wherein the primary, residential caregiver is the target'sspouse.
 14. The communications network of claim 12, wherein the primary,residential caregiver is the target's child.
 15. A purposefullysupported communications system which increases affective communication,activity stimulating communication and intellectually stimulatingcommunication between an elder and a caregroup associated with the elderthereby (i) reducing risk of disease, depression and physical and mentaldecline, and (ii) increasing longevity, activity and quality of life.16. A method comprising: providing a closed communication serviceconfigured to facilitate and encourage communications among a pluralityof members of a caregroup and a target of the caregroup, the target ofthe caregroup using a hardcopy-based communication appliance associatedwith the caregroup to transmit and receive electronic communications viathe closed communication service to or from the plurality of members ofthe caregroup; and facilitating identification, creation and delivery ofappropriate member-to-member and member-to-target coaching messages byproviding within the closed communication service one or more tools thatallow one or more administrating caregivers of the plurality of membersof the caregroup to view metrics relating to electronic communicationsexchanged via the closed communication service.
 17. The method of claim16, further comprising providing within the closed communication serviceone or more tools that allow the one or more administrating caregiversto include within the coaching messages suggestions regardingappropriate types of digital gifts that may be sent via the closedcommunication service.
 18. The method of claim 16, further comprisingproviding within the closed communication service one or more tools thatprovide information to healthcare providing caregivers to assess anddiagnose the condition of the target and to make prognoses regarding thecondition of the target and to deliver and receive privatecommunications with a patient, primary caregiver, or administratingcaregiver.
 19. The method of claim 16, wherein the metrics include oneor more of: a rating regarding an affective-emotional value ofelectronic communications received by the target of the caregroup; arating regarding an intellectual stimulus value of the electroniccommunications received by the target of the caregroup; a ratingregarding activity induced value of the electronic communicationsreceived by the target of the caregroup; information provided bycaregivers or target to the closed communication service or healthcareproviding caregivers; information interpreted by healthcare providingcaregivers; information regarding historical norms of electroniccommunications frequencies with the target of the caregroup byindividual members of the plurality of members of the caregroup.
 20. Themethod of claim 16, further comprising enrolling a subject withAlzheimer's disease and a family support network associated with thesubject to participate in the communication service.
 21. The method ofclaim 20, wherein participation in the communication service amelioratesor slows the progression of the subject's symptoms associated withAlzheimer's disease.
 22. The method of claim 16, further comprisingenrolling a subject at risk of developing Alzheimer's disease and afamily support network associated with the subject to participate in thecommunication service.
 23. The method of claim 20, wherein participationin the communication service decreases the subject's risk of developingAlzheimer's disease.
 24. The method of claim 16, further comprisingenrolling a subject at risk of developing depression and a familysupport network associated with the subject to participate in thecommunication service.
 25. The method of claim 20, wherein participationin the communication service decreases the subject's risk of developingdepression.
 26. The method of claim 16, further comprising enrolling asubject at risk of developing stress and a family support networkassociated with the subject to participate in the communication service.27. The method of claim 20, wherein participation in the communicationservice decreases the subject's risk of developing stress or reduces thesubject's stress.
 28. The method of claim 16, further comprisingenrolling a subject at risk of developing physical illness and a familysupport network associated with the subject to participate in thecommunication service.
 29. The method of claim 20, wherein participationin the communication service decreases the subject's risk of developingphysical illness.
 30. The method of claim 16, further comprisingenrolling a subject at risk of developing cancer and a family supportnetwork associated with the subject to participate in the communicationservice.
 31. The method of claim 20, wherein participation in thecommunication service decreases the subject's risk of developing cancer.32. The method of claim 16, further comprising enrolling a subject atrisk of developing heart disease and a family support network associatedwith the subject to participate in the communication service.
 33. Themethod of claim 20, wherein participation in the communication servicedecreases the subject's risk of developing heart disease.
 34. The methodof claim 16, further comprising enrolling an elder subject having achronic condition and a family support network associated with the eldersubject to participate in the communication service.
 35. The method ofclaim 20, wherein participation in the communication service slowsprogression of the elder subject's chronic condition.
 36. The method ofclaim 20, wherein participation in the communication service improvesthe elder subject's compliance with one or more of a drug therapyregimen and a physical therapy regimen.
 37. The method of claim 16,further comprising enrolling an elder subject and a family supportnetwork associated with the elder subject to participate in thecommunication service.
 38. The method of claim 20, wherein participationin the communication service improves the health and well-being of theelder subject.
 39. The method of claim 20, wherein participation in thecommunication service improves the health and well-being of one or moremembers of the family support network.
 40. The method of claim 16,further comprising enrolling an elder subject at risk of developing ageriatric cognitive disorder and a family support network associatedwith the elder subject to participate in the communication service. 41.The method of claim 20, wherein participation in the communicationservice decreases the subject's risk of developing a geriatric cognitivedisorder, reduces the severity of the geriatric cognitive disorder, ordelays the onset of the geriatric cognitive disorder.
 42. The method ofclaim 16, further comprising enrolling a subject with dementia and afamily support network associated with the subject to participate in thecommunication service.
 43. The method of claim 20, wherein participationin the communication service ameliorates the subject's symptomsassociated with dementia.
 44. A closed communication service tofacilitate and encourage electronic communications among members of acaregroup and a subject that is a target of the caregroup as a method ofsupporting a spouse of the subject and preventing one or more ofdepression, stress and physical illness due to caregiving activitiesperformed by the spouse on behalf of the subject.
 45. A methodcomprising: providing a communication service configured to facilitateand encourage communications among a plurality of members of a caregroupand a subject that is a target of the caregroup, the subject using adigital mailbox appliance associated with the caregroup to transmit andreceive electronic communications via the communication service to orfrom the plurality of members of the caregroup; capturing informationregarding communications among the plurality of members of the caregroupand the subject via the communication service; and providing informationto healthcare providing caregivers to assess and diagnose the conditionof the subject and to make prognoses regarding the condition of thesubject.
 46. A method comprising: providing a communication serviceconfigured to facilitate and encourage communications among a pluralityof members of a caregroup and a subject that is a target of thecaregroup, the subject using a hardcopy-based communication applianceassociated with the caregroup to transmit and receive electroniccommunications via the communication service to or from the plurality ofmembers of the caregroup; capturing information regarding communicationsexchanged among the plurality of members of the caregroup and thesubject via the communication service; calculating one or more metricsbased on the captured information; and based on the one or more metrics,the communication service automatically generating and deliveringcoaching messages in an effort to encourage a set of goals, includingone or more of (i) frequent communications among the plurality ofmembers of the caregroup and the subject, (ii) affective communications,(iii) stimulating or activity inducing communications; and (iv)communications with ex officio caregivers who are professionalhealthcare providers.
 47. The method of claim 46, wherein the coachingmessages include suggestions regarding use of appropriate digital giftsconsistent with the set of goals.
 48. The method of claim 46, whereinthe metrics include one or more of: a rating regarding anaffective-emotional value of communications received by the subject; arating regarding an intellectual stimulus value of communicationsreceived by the subject; a rating regarding activity induced value ofthe communications received by the subject; information provided bycaregivers or the subject to the communication service or healthcareproviding caregivers; information interpreted by healthcare providingcaregivers; information regarding historical norms of communicationsfrequencies with the subject by individual members of the plurality ofmembers of the caregroup.
 49. A closed communication service tofacilitate and encourage electronic communications among members of acaregroup and an elder subject that is a target of the caregroup as amethod of facilitating one or more of (i) diagnosis of the eldersubject's mental or physical status, (ii) evaluation of the eldersubject's response to closed communication service stimuli andtreatments and condition over time; and (iii) making prognoses regardingprogression of physical or mental condition, disability, disease orchronic conditions of the elder subject.
 50. A method of analyzingaggregate data from a plurality of caregroups participating in a closedcommunication service to facilitate diagnosis of subpopulations ofdisease or disability and evaluate or discover new methods of diagnosisor intervention strategies to slow, ameliorate, prevent or remediatechronic conditions in elders or those with mental or physicalconditions, disabilities or diseases.
 51. A closed communication serviceto facilitate and encourage electronic communications among members of acaregroup and a target of the caregroup as a method of providinginformation to family members regarding indications of physical ormental condition, disorder, disability or illness of a participatingfamily member.
 52. The closed communication service of claim 51, whereinthe participating family member is a primary caregiver.
 53. The closedcommunication service of claim 52, wherein the primary caregiver is aspouse of the target.
 54. The closed communication service of claim 52,wherein the primary caregiver is a child of the target.